FREE acro & hip hop workshops

Student name *

First Name

Last Name

Parent/Carer Name

If student is under 18yrs

First Name

Last Name

Acrobatics

Junior *FULL*

Intermediate

Senior

Hip Hop

Junior

Intermediate

Senior

Medical *

Please select if you/your child suffer from any of the following

ALLERGIES

ASTHMA/RESPIRATORY PROBLEMS

DIABETES

DYSLEXIA/LEARNING DIFFICULTIES

EPILEPSY

HEARING IMPAIRMENT

MIGRAINE/DIZZINESS

MUSCULAR/JOINT PROBLEMS

RECENT SURGERIES

VISION IMPAIRMENT

OTHER

NONE OF THE ABOVE

Consent *

I understand that some physical contact may be necessary by a staff member to demonstrate exercises or technique during classes. I accept that Vital Movement Studios trained staff will administer first aid and/or call emergency services in the case of any accident or injury during class, and that I will be sent any subsequent medical bills. While Vital Movement Studios takes all reasonable care in the conduct of its classes, I acknowledge that there is possible risk of injury involved with participation in dance. In allowing myself/my child(ren) to participate in Vital Movement Studios activities, I hereby assume all the risks associated with the performing arts. I understand the importance of myself and my child(ren) following the instructions and rules set by their teacher/s, and I agree to release Vital Movement Studios and its staff of any and all liability which may arise as a result of my/my child(ren)’s participation in activities at Vital Movement Studios.

Yes