Registration

Student Registration

* Indicates required field

Name *

First

Last

Parent's Name (if applicable) *

First

Last

City *

State *

Email (Gmail Preferred) *

Phone Number *

Gender *

Female Male

Age *

Injury Waiver *

I understand that dancing is a physical activity that may result in physical injury and I will not hold Nickelz Production liable for any extent of an injury that may result from participating in a Nickelz Production Dance Class. I understand that I should be aware of my physical limitation and agree not to exceed them. If I am signing this waiver for my child, I certify that I am the parent or legal guardian and have the right to waive these rights on behalf of the dance student named above.

Photography/Media *

Yes, I grant permission for Nickelz Production to use photography and video taken during class or Nickelz Production sponsored events for publicity purposes of the student name above

Reuse of Choreography *

I understand that the video of the choreography sent to me after class is only intended for personal use and cannot be reproduced or taught again in a professional manner without the consent of the original choreographer.

Submit