Free Trial/ Placement Class Waiver

Santa Rosa Dance Theater

569 Summerfield Road

Santa Rosa, CA 95405

707-539-0516

Please fill out one form per dancer

Please read the following terms and agreements:

DRESS CODE

Santa Rosa Dance Theater has a dress code policy for every class. Please see our dress code policy on our website here: https://www.santarosadancetheater.com/dress-code. Trial classes are flexible with dress code as some dancers may end up being placed in a different level with different dress code after trial class. I understand and agree to the terms regarding dress code as mentioned above.

PLACEMENT

I understand that I am registering myself/ my dancer for a trial class, during which, I may be assessed by the instructor for appropriate skill level and level placement. I understand SRDT has a school-wide curriculum with class objectives that must be met before progressing in level. I agree to trial a class that matches the class age and experience level description only. I understand level placement is up to the discretion of the instructor and owner/ director of the school.

MEDIA WAIVER

Santa Rosa Dance Theater and it's employees use images for educational, promotional, advertising and other purposes that support the mission of SRDT. I hereby grant SRDT permission to use my child’s / my own images in marketing, materials, such as, but not limited to, newspaper articles, social media and website publication. I grant SRDT all rights to use images in any medium and I understand that all rights to these images belong to Santa Rosa Dance Theater. SHould I disagree to these terms, I will submit my request in writing to Santarosadancetheater@gmail.com.

LIABILITY WAIVER

I, the undersigned, release and discharge Santa Rosa Dance Theater, and its staff, officers, directors, agents and volunteers from any and all liability arising from, related to, or connected with any injury or illness or damage caused by or sustained in the course of any participation in classes, performances, or other activities conducted by or associated with Santa Rosa Dance Theater. I am aware that participating in dance classes and performances can result in injuries, and I am voluntarily participating in those activities with knowledge of the danger involved and I hereby attest that the Waiver of Liability is provided voluntarily upon submission of this form and shall be fully binding upon me, my heirs, next of kin, executor, administrator, and/or personal representative. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between me and the Santa Rosa Dance Theater of Sonoma County and/or its affiliated organizations and I sign of my own free will.

ILLNESS AGREEMENT

I understand that the risk of becoming exposed to and/or infected by COVID-19 or other illnesses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other students and their families while at the studio. I/my child voluntarily seek services provided by Santa Rosa Dance Theater and acknowledge that I/my child is increasing his/her risk to exposure to the Coronavirus/COVID-19 or other illnesses. I acknowledge that I/my child must comply with all set procedures to reduce the spread of illness while attending my class. 

I attest that: 

* I/my child is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. 

* I do not believe I/my child have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19 or other illness. 

* I/my child have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. 

* I/my child is following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Santa Rosa Dance Theater harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the studio, or that may otherwise arise in any way in connection with any services received from Santa Rosa Dance Theater. I understand that this release discharges Santa Rosa Dance Theater from any liability or claim that I, my heirs, or any personal representatives may have against the studio.

PERMISSION FOR PHYSICAL THERAPY SERVICES:

I understand that the owner of Santa Rosa Dance Theater, Dr. Christa Christianson, is a licensed physical therapist and may occasionally provide physical therapy services to dancers who experience physical limitations or complaints of pain. I give my permission for Dr. Christa Christianson to assess and treat my child for any physical issues that may arise during their participation in dance activities at Dance Evolution.

I acknowledge that physical therapy involves physical manipulation and exercises that may carry some risk of injury. I agree to release and hold harmless Dr. Christa Christianson, DPT, Dance Evolution, its employees, instructors, and agents from any and all claims, actions, and demands of any nature arising out of or related to any loss, damage, or injury that may be sustained by my child as a result of receiving physical therapy services.