Registration 08

Chinese Folk Dancing Troupe From Lily Art Studio Registration Form STUDENTS Last Name

First Name

Grade

DOB

Home School

Mailing Address

City/Town

Email Address

Phone #

Would you like to volunteer?

Yes_____

Emergency Contact Name

State

Zip

Emergency Phone #

NO_____

Father’s name

Phone or cell #

Mother’s name

Phone or cell #

Registration Fee $5 per student, one time fee. *Cost –1st family member for class and performance ($50 per month) Tuition – 2nd/3rd family member for All other classes ($45 per additional student; x ____ of students

$

Donation (Not accepted at this time)

$

$ $

$

= Total Amount •

(payable to Lily Art Studio) The intention of the cost is for space rental, instructor’s time, audio-video material, costume and other costs associated with performance. The cost may subject to change depending on the operation expense.

To sign up:  

Submit the completed form and payment to Lily’s Art Studio, Website: lilyartstudio.ning.com

Class Schedule:  3:00 PM – 4:00 PM, Saturdays (Class A)  4:00 PM – 5:00 PM, Saturdays (Class B) Class Locations: 

LaCamas Swim & Sport Center, 2950 NW 38th Avenue, Camas, WA 98607, (360) 834-8506.

Month Sep Oct Nov Dec Jan Jan Add Feb

0 4 1 6 3 7

Saturday 0 0 11 18

27 25

8 13 10 11 14

23 0 24 25 28

15 0 17 21

31

Costume Policy: The studio will lend the performance costumes to students subject to availability. The shaded area is reserved for administration use only:

Check # _________ Check Date # __________

lilyartstudio.ning.com

Amount $ __________ Receiver Initial ________ Date: ____________

Phone # 360-210-5798, [email protected]

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Chinese Folk Dancing Troupe From Lily Art Studio Programs: 1. Class A: Level I class offers elementary school aged children (expected ages 6 to 11-years-old) the opportunity to learn basic forms of Chinese folk dance. Structured basic training is also offered but not emphasized here. Students are expected to perform at the Chinese New Years Party. 2. Class B: Level II & III class is intended for advanced students who have done some basic dance trainings and ready for artistic and skilled enhancement. Students are expected to perform at the Chinese New Years Party. RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION of being permitted to utilize the facilities, services and programs of Lily Art Studio for any purpose, including, but not limited to observation or use of facilities, equipment or materials, or participation in any offsite program affiliated with Lily Art Studio, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into Lily Art Studio or rented space for observation or use of any facilities, equipment or materials or participation in such affiliated program constitutes an acknowledgment that such premises and all facilities, equipment or materials thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Lily Art Studio, its directors, officers, employees, sponsors, consultants, volunteers, property owners and their respective agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any photo or video taking, any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, or about the premises or any facilities, equipment or materials therein or participating in any program affiliated with Lily Art Studio. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage or cost they may incur due to the negligence, intentional act or other contributory act of the undersigned or such children in, upon or about Lily Art Studio premises or in any way observing or using any facilities, equipment or materials of Lily Art Studio or participating in any program affiliated with Lily Art Studio whether caused by the negligence of the releasees or otherwise. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to the negligence of releasee or otherwise while, in about or upon the premises of Lily Art Studio and/or while using the premises or any facilities, equipment or materials thereon or participating in any program affiliated with Lily Art Studio. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of New Hampshire and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. For all students under the age of 18: CONSENT AND RELEASE OF PARENT OR LEGAL GUARDIAN: I am the parent or legal guardian of my children indicated in the registration form. I consent to my Children’s participation in Lily Art Studio. I HAVE READ AND I UNDERSTAND the RELEASE AGREEMENT. In consideration of allowing my Child to participate, I agree that THE TERMS OF THIS RELEASE SHALL LIKEWISE BIND ME, MY CHILDREN, my heirs, legal representatives, and assignees. I HEREBY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM AND ANY LIABILITY that I or my Children may allege against the Releasees (including reasonable attorney’s fees or costs) as a direct or indirect result of injury to me or my Child because of my Child’s participation in the programs, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE RELEASEES or others. I PROMISE NOT TO SUE RELEASEES on my behalf or on behalf of my Children regarding any claim arising from my Children’s participation in the programs.

Adult student/Parent/Guardian Signature: ______________________________________ Date: ____________________

lilyartstudio.ning.com

Phone # 360-210-5798, [email protected]

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