Free Trial Class Request

Parent Name*

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Student Name*

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Student Age*

Please enter a number from 2 to 70.

Student Birthday*

Gender*

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Date of Trial*

Does your dancer want to do their trial In-Person or via Zoom?*

In-Person
Zoom

Is there any other classes your student is interested in trying out with us?*

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Additional Class Requesting to Try

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Date of Trial

Does your dancer want to do their trial In-Person or via Zoom?

In-Person
Zoom

Does your student have previous dance experience? If YES, how many years?*

How did you hear about us?*

Is there anything else you would like us to note? If a friend referred you list below!*

List N/A if you don't have anything to note

Note: If you are requesting a trial class for another student please submit a separate trial form.

Consent*

COVID-19 LIABILITY WAIVER AND AGREEMENT:

I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntarily assume the risk that I and/or my children may be exposed to or infected by COVID-19 by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand the risk of becoming exposed to or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, volunteers, and program participants and their families.

I agree that my child(children) do not currently, nor have had in the last two weeks a fever, cold, vomiting, diarrhea, cough, sore throat, chills, muscle pain, fatigue, shortness of breath and/or loss of taste or smell. To the best of my knowledge, I affirm that I, as well as those living in my household, have not been diagnosed with COVID-19 or knowingly been exposed to anyone diagnosed with COVID-19 within the last 14 days.

If I, or anyone else, I have knowingly been exposed to is diagnosed with COVID-19, I will only
return to Dual Star Academy of Dance after 14 days without symptoms and/or being cleared of COVID-19 by a doctor.

Medical Agreement
I understand that dancing is a strenuous physical activity. To my knowledge, my child has no medical problems or injuries that would prevent participation in class. I understand that it is my responsibility to inform a physician of any medical issues and to obtain written consent for participation. I agree to inform the instructor(s) of any known health condition that may affect class participation.

Injury Agreement
I agree to release Dual Star Academy of Dance and its participants, or any instructor from liability related to accidents or injury. I also agree to communicate in the event of an injury and understand that physical clearance from a doctor may be required to return to participating in class.

I agree to the following COVID-19, Medical and Injury Agreement

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Trial Class 2020-2021

Important Dates

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