PLEASE COMPLETE THE FOLLOWING FORMS:


EMERGENCY CONTACT INFORMATION:

Name of Student *
Name of Student
Please enter the address where you will be staying during the intensive.
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Please indicate if airborne
Please include any additional medical or personal information you would want an emergency medical provider to know.

PHOTO/VIDEO RELEASE:

AXIS Dance Company is a non-profit arts organization and therefore we rely on our outreach and media efforts to engage our publics and share our work. From time to time, we require photographs, videos and other images of people involved in our programs, events, workshops and classes. The purpose of these images is to support AXIS Dance Company.

I hereby give AXIS Dance Company and all persons acting under AXIS’ permission the right to use my name, picture, portrait, photograph and video. I understand that any of the aforementioned may appear in print and digital formats, including but not limited to social media such as Facebook, Instagram, Twitter, the AXIS website and blog. I waive any right to inspect or approve the photograph(s) or video(s) or any collateral incorporating the photograph(s) or video(s). I agree that the photographer or AXIS Dance Company owns the copyright to these photographs in all cases. 

All revenue generated by the distribution of said photograph(s) and/or video(s) will be used for the sole support of outreach, educational programs, and performance expenses of AXIS Dance Company, a non-profit tax-exempt organization. I agree that I will not receive payment for my participation in any photograph(s) or video(s) produced by AXIS Dance Company.  

I agree that this release shall be binding on me, my legal representatives, heirs, and assigns. I have read this release and am familiar with its contents.

Name of Student *
Name of Student
By typing your name and clicking "submit," you agree to the terms of the above photo release.
Name of Legal Guardian (Students under 18 only)
Name of Legal Guardian (Students under 18 only)
If student is under 18, their legal guardian must read and complete this form on behalf of the student.
mm/dd/yyyy

HOLD HARMLESS AGREEMENT:

Notification of Personal Risk

Dance classes use varying levels of physical effort. We want participants and parents to be aware of the inherent risks to bodily injury resulting from dance; however, every precaution is taken to avoid injury, encourage safety, and teach self-care. 

Policy of Personal Property and Valuables

AXIS will not be responsible for theft, loss, or damage of personal property occurring during the Summer Intensive. Please use discretion when choosing what to bring to class, and do not leave personal items unattended. 

Hold Harmless Agreement

I agree to hold harmless AXIS Dance Company, against any and all injuries, cost, losses, damages and expenses (including attorney's fees) which I might suffer from participation in any class, production, rehearsal, or event of whatever kind or character and without limitation.

By signing this agreement I understand and am waiving any claims, liens, demands, or causes of action, which I may now or in the future possess against AXIS Dance Company arising out of or in any way related to my participation in any production, rehearsal, or event.

Name of Student *
Name of Student
By typing your name and clicking "submit," you agree to the terms of the above hold harmless agreement.
Name of Legal Guardian (Students under 18 only)
Name of Legal Guardian (Students under 18 only)
If student is under 18, their legal guardian must read and complete this form on behalf of the student.
Date
Date

PRE-SURVEY:

Name
Name
Please indicate the categories in which you have prior experience.
Please list three learning areas.
Demographic Information
Our funders require us to report on the different demographics that we serve. We appreciate your participation.
What do you identify as your race/ethnicity?
What is your household income?