Bravenet Contact Forms

Order Form

Student's Name:

Age:

Birthdate:

Address:

City, State, Zip:

Home Phone:

Cell Phones:

Work Phones:

Both Parents' Names:

Email:

Class Enrolling In:

Class Day and Time:

Emergency Contact:

Liability Release: By clicking the submit button below, I, as parent/legal guardian of my children, approve and give my permission for him/her to be a student at Cinderella Dance, Gym and Cheer. I also understand that his/her participation in dance / gymnastics / cheerleading activities involves motion, rotation and weight in a unique environment and, as such, carries with it a reasonable assumption of risk. I understand that I am responsible for any and all hospitalization, medical or emergency treatment by providing proper insurance coverage, or will assume the cost due to injury. I will not hold Cinderella Dance, Gym and Cheer, or any of its' staff, responsible in any way for such costs which may occur. I have reviewed the Rules and Policies of Cinderella Dance, Gym and Cheer and understand that I am the only responsible party for his/her actions while participating in all studio activities. In case of an emergency, Cinderella Dance, Gym and Cheer's staff has my permission to request medical attention for my child. I agree that this waiver of liability and policy is binding and that my children can not enter the gym or dance area otherwise. I give Cinderella Dance, Gym and Cheer permission to use photographs of my child for promotion. I will notify Cinderella Dance, Gym and Cheer, in writing, one month prior to withdrawing him/her from a class or leaving the studio/gym. Otherwise, I will be held responsible for any and all charges incurred until such notice is received by Cinderella Dance, Gym and Cheer By typing my name and enrolling my child I agree to the above waiver and have read and agree to their policy on this on this website. I agree that there are no refunds of any tuitions, competition fees or uniform fees. All fundraising fees belong to Cinderella to use for Cinderella's Athletes. Should I leave Cinderella for any reason I forfeit any fundraising monies and agree that my funds go to Cinderella Athletes that stay with the gym.

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