Southwest Classical Dance Institute - Master Class Series Registration

Master Class Series Registration

Students may submit Registrations and Payments at one of SCDI's Partner Schools, by mail, or online. For a printable version of this Registration Form please click here. If you would like to apply for a scholarship please go to our Scholarship Page and download an application. *Indicates a required field.
Student Information
*First Name:	*Last Name:	*Gender:

*Address:	*City:	*State:	*Zip Code:

*Phone: (xxx-xxx-xxxx)	*Date Of Birth: (must be 10 by 6/1/2012)		*Age:

*I would like to register for...
Optional Student Information
Where are you currently studying dance?	How did you hear about SCDI's Master Class Series?

Ethnic Origin: (optional)
Caucasian African American Asian Latino Native American Pacific Islander

Primary Contact Information (Parent or Gaurdian)
*First Name :	*Last Name:	*Relationship to Student:

*Email Address:	*Email Address Confirmation:	*Emergency Phone Number:

Parent / Minor Waiver and Release of Liability Consent and Assumption of Risk and Indemnity Agreement

IN CONSIDERATION of being permitted enrollment in and use of the facilities of Southwest Classical Dance Institute, THE PARENT(S) AND/OR LEGAL GUARDIAN(S) of the student named above EACH INDIVIDUALLY:

UNDERSTAND there are certain RISKS OF INJURY inherent to ballet and other forms of dance, and the use of the facilities for that purpose, and I am WILLING TO ASSUME THESE RISKS on behalf of my child.
Hereby CERTIFY that my child is FULLY CAPABLE OF PARTICIPATING in the dance activities of Southwest Classical Dance Institute, responsibly use the facilities of the Institute and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in Southwest Classical Dance Institute Programs, except as listed below.
Hereby give my FULL CONSENT AND APPROVAL for my child to use the facilities of Southwest Classical Dance Institute.
Hereby WAIVE, RELEASE, HOLD HARMLESS AND COVENANT NOT TO SUE Southwest Classical Dance Institute, its officers, employees and other representatives, for all claims made on account of an injury suffered by my child in the normal course of ballet and other dance classes, and or other use of the facilities, whether THE RESULT OF NEGLIGENCE OR ANY OTHER CAUSE.
Hereby AGREE TO REIMBURSE Southwest Classical Dance Institute and their insurance company for ANY MONEY which they pay to the child, if the child subsequently makes a claim against the Sponsoring Organization despite this agreement.

*I HAVE READ THIS Waiver and Release of Liability, Assumption of Risk and Indemnity AGREEMENT, UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS by entering my name below, and have ENTERED MY NAME FREELY AND VOLUNTARILY without any inducement.

Photography Waiver

* I hereby irrevocably consent to and authorize the use and reproduction by Southwest Classical Dance Institute or anyone authorized by Southwest Classical Dance Institute of any and all photographs taken of me/my child by Southwest Classical Dance Institute and its representatives for any purpose deemed appropriate by Southwest Classical Dance Institute. This includes but is not limited to advertising and other publicity, as well as website promotion and the like.

*Entering your name in the box to the right represents your agreement to the above.

Please note that by clicking the "Register" button below your information will be sent to SCDI's Registrar and you agree to pay the registration fee as well as the tuition amount for the selected registration option. A student's place in the program will not be held until the tuition balance is paid in full. You will be added to SCDI's mailing list and kept up to date with new programs, services, and scholarship opportunities. Southwest Classical Dance Institute admits students of any race, color, national origin, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school, and does not discriminate on the basis of race, color, national origin, and ethnic origin in administration of its educational policies, admission policies, scholarship programs, and other school-administered programs.

I would like to join SCDI's email mailing list to receive notifications about new programs and services including scholarship opportunities. I understand that I can unsubscribe at any time.

Students receiving corrections from Rudolf Kharatian.