Resources – Mwendo Dance

First Name

Last Name

Birthday

Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Zip

Instagram

Parent/Guardian Name

Parent/Guardian Email

Telephone

Emergency Contact Name

Relationship to Dancer

Emergency Contact Number

Physician Name

Physician Telephone

Health Card Number

Health Concerns (medications, allergies, etc.)

Dance Categories: Check dancers age & additional classes dancer will be participating in:

Dance Genre's: Check or circle dancers main interests (dancers will still learn and explore other genres)

Other ( any information you think would be helpful for us to know):

Email^*

Referred by (If Applicable)

Terms and Conditions

Physical activities such as dance, drama and musical theatre can put participants at risk of injury. I understand and agree that by participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury, damage, loss or death. I acknowledge that I understand the nature of the activities my child will be participating in and that my child is in the proper physical condition and capable of participating in the related activities, understanding that Mwendo Dance Co. (Mwendo, MW) is not in any way responsible for making such a determination. Therefore I voluntarily agree, to assume all risks and responsibility for any such injury or accident, which might occur to myself, my child or any other family members during the course of involvement with Mwendo Dance Co. This includes classes, rehearsals, performances, or any Mwendo activities or space Mwendo Dance Co. participates, practices or performs at. I acknowledge and agree that it is my responsibility to maintain my own accident and health insurance coverage that provides adequate coverage for myself and my child participating in Mwendo Dance Co. activities and that Mwendo Dance Co. does not provide accident or health insurance for those participating in its activities, programs, or under its instruction.

I also exempt, release, and indemnify Mwendo Dance Co., its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Mwendo Dance Co. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Mwendo Dance Co., its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. In consideration of my child’s enrolment in any dance instruction program, I understand and agree on behalf of myself and my child, to release, hold harmless, and discharge Mwendo Dance Co. from all claims, costs, liabilities, expenses or judgments, including attorneys’ fees and court costs for any occurrences in connection with any dance instruction

I accept

Agreed

I have read and gone over the terms of the manual with my child and have agreed to all content regarding Mwendo Dance Company manual. I agree to uphold the regulations to the best of my ability as well as understanding the punishments and disciplinary actions that will be made by Mwendo instructors and/or authorities.
*Without this contract dancers will not be able to participate in any programming*

Read and Agreed to all content

Registration is only completed & recognized once first month payment is complete & don’t forget to read/download your mw manual

Online Registration Form