Regent Park Dance – Summer Intensive Registration Form PARTICIPANT Participant Name Age 101112131415 Phone Address End of Day My child is free to leave at the end of class to return home on their own.I will pick up my child from the lobby at 2:45pm sharp. PARENT/GUARDIAN Parent/Guardian Name Phone Email EMERGENCY CONTACT Contact Name Relationship to Participant Contact Phone REGENT PARK DANCE CREATIVE AGREEMENT In order to create a safe and collaborative space for all participants, we have created the following agreement regarding participation and creation: All voices are important and should be heard. Respect everyone’s experiences/opinions without passing judgment. Laugh and have fun! But… Do not laugh ‘at’ others’ questions or ideas. Be on time. Be committed, Be present. Commit to staying on task – gage how much you dominate the discussion/creation. Provide gentle encouragement to those who may want to contribute, but may be too shy to participate. Practice the use of inclusive pronouns as people request them. Be respectful both in person and on social media. By signing below I acknowledge that the participant has read, understands and agrees to the Regent Park Dance Creative Agreement. MEDIA RELEASE FORM I, the individual pictured/filmed/videoed, do hereby grant permission to Kick Start Arts Society, their Artistic Directors and assigns to use and reproduce any media, video footage, audio recording, or photographs taken/used during the process of participating in the dance/choreography classes which are part of Regent Park Dance for use on television, in festivals, and shows, in workshops, or in print, on the internet, or any other format, in any manner suitable to promote and air this project, or others created in the future. Where appropriate, Kick Start Arts Society will acknowledge participants fully for their role. By signing below I, the parent/guardian, acknowledge, understand and agree to the Regent Park Dance Media Release Form. INJURY RISK DISCLAIMER I/we (the dancer and parent/guardian) realize that participation in dance classes and activities could result in some possible personal injury. Despite precautions being taken by Kick Start Arts Society and our instructors, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Kick Start Arts Society. I/we (the dancer and parent/guardian) agree to release from responsibility Kick Start Arts Society, instructor Vanessa Mangar, our Artistic Directors, Board, and any other artist-educators involved from any cause of action, claims, or demands now and in the future. I/we (the dancer and parent/guardian) will not hold Kick Start Arts Society, liable for any personal injury including: scrapes, bruises, cuts, sprains, fractures, broken bones, concussions, death or other injuries, or any personal property damage/loss, which may occur on the premises before, during or after classes. I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Kick Start Arts Society. In the event that I/we (the dancer and parent/guardian) should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to Vanessa Mangar, Instructor, and the Artistic Director, as soon as possible. By signing below I acknowledge that I, the parent/guardian of the participant, have read, understand and agree to the Regent Park Dance Injury Risk Disclaimer. COVID-19 ADVISORY Please be advised. We are following all current COVID 19 guidelines. Participants are not required to wear a mask, but they are welcome to wear one if they wish to. In order to keep participants as protected as possible, when you register, you are agreeing that each day, prior to class, you will do the following check with your child. Do they have: Runny nose or nasal congestion Headache Extreme fatigue or tiredness Sore throat Muscle aches or joint pain Gastrointestinal symptoms (such as vomiting or diarrhea) Loss of taste or smell Have they come in contact in the last week with anyone who is sick with COVID 19? If you answer yes to any of these questions, you agree your child will not attend class, to protect others in the group. By signing below I acknowledge that I, the parent/guardian of the participant, have read, understand and agree to the Regent Park Dance COVID-19 advisory and precautions. Parent/Guardian Signature Date Reset Form TAKE ME BACK TO THE INFORMATION PAGE