Participant & Primary Contact Information

Name of Participant *

First Name

Last Name

Participant's Date of Birth *

MM

DD

YYYY

Phone of Participant or Primary Contact *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Emergency Contact *

First Name

Last Name

Phone of Emergency Contact *

(###)

###

####

Liability Waiver *

I, the parent or legal guardian (now on referred to as Primary Contact) of myself or the child listed in this registration form, realize that participation in dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/we assume all risks related to using any and all spaces used by and programs, activities, rehearsals or shows run by Give Me Brilliance (now on referred to as GMB). I/we agree to release and hold harmless GMB, including its teachers, dancers, staff members, volunteers and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold GMB liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behaviour in addition to any damage I/we may cause to the facilities utilized by GMB. Finally, I/we agree to inform GMB of any physical limitations my child has before starting any programs with GMB and with the understanding that my child's doctor has approved participation in physical activities such as dance.

Agree

Disagree

Image Capture Waiver *

I, the Primary Contact, understand the Photo and Video Release, or Image Capture Waiver, which means that I agree to the use of images of me or my child by GMB on the GMB website, social media pages, in brochures or in other promotional materials. I understand that no identifying information will be included.

Agree

Disagree

Payment Agreement *

I, the Primary Contact of the dancer indicated by name in this registration form, understand that I am taking sole responsibility for any tuition, registration and/or costume fees associated with the classes I have registered my child in. By registering myself or my child, I am committing to any and all associated fees before myself or my child is able to participate in any activity. Should I fail to complete payment of said fees, I understand myself or my child may not be able to participate. I understand that any payment arrangements with other family members, including the other biological parent of said child who is not residing in the same residence as myself, is my sole responsibility to organize. I understand that GMB is unable to invoice anyone other than myself for fees associated with mine or my child's class unless a separate Payment Agreement is signed by any other party taking responsibility for payment, and that Agreement is emailed to support@gmbdancer.com, or appropriate court documents naming both parents responsible for payment can be produced. For families who are in need of a separate Payment Form please email: support@gmbdancer.com

Agree

Disagree

Payment Policies *

I, the Primary Contact, agree to GMB's payment and refund policies: 1) All fees must be paid before the first class of each session. Payments can be made via e-transfer to support@gmbdancer.com, cash or credit card via a secure link. 2) Should my child or I wish to cancel enrolment after a session has begun, GMB must be notified via email at support@gmbdancer.com prior to the third class for eligibility of a refund of remaining classes (not applicable to any already taken). 3) GMB reserves the right to cancel any class without sufficient registration. In the event of a class cancellation, students who registered and paid for the class will receive a full refund.

Agree

Disagree