Contact Information and Waiver for Get in the Groove for Preschool 3 hour classes - please complete the form below:

Which class(es) are you registering for? *
Please check all classes your child is registered for.
Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Parent/Guardian (A) Name *
Parent/Guardian (A) Name
Parent/Guardian (A) Cell Phone Number *
Parent/Guardian (A) Cell Phone Number
Parent/Guardian (A) Home Phone Number *
Parent/Guardian (A) Home Phone Number
Parent/Guardian (A) Work Phone Number
Parent/Guardian (A) Work Phone Number
Parent/Guardian (B) Name
Parent/Guardian (B) Name
Parent/Guardian (B) Cell Phone Number
Parent/Guardian (B) Cell Phone Number
Parent/Guardian (B) Home Phone Number
Parent/Guardian (B) Home Phone Number
Emergency Contact's Name *
Emergency Contact's Name
Emergency Contact's Phone Number *
Emergency Contact's Phone Number
Nanny's Name (if a nanny will be bringing your child to class) *
Nanny's Name (if a nanny will be bringing your child to class)
Nanny's Phone Number *
Nanny's Phone Number
If so, please provide details below.
Mailing address *
Mailing address
Waiver/Medical/Publicity Release - please read *
Please read the information below and then sign the agreement by typing your name in the box below: LIABILITY AND ASSUMPTION OF RISK I understand that my child will be attending Get in the Groove for Preschool classes at Garden Street School of the Performing Arts (located at 1018 Washington Street, 3rd floor) at his, her or my own risk and I will not hold the officers, directors, independent contractors, volunteers, or employees of Creative Groove Studio responsible for any injuries or damages received by the aforementioned student. I acknowledge my acceptance of this Assumption of Risk by agreeing to and allowing my child to participate in such class. MEDICAL EMERGENCIES I hereby authorize the employees of Creative Groove Studio, an identified additional parent/guardian on the registration form, or the identified Emergency Contact to act as my agent and to consent to medical, surgical, or dental examination and/or treatment that may be necessary. I hereby authorize Creative Groove Studio's employees to perform any acts which may be necessary or property to provide emergency health care of my child in the event that the parent/guardian and/or Emergency Contact cannot be reached, including consent to and authorization of medical procedures by qualified, licensed physicians, dentists, hospital or emergency medical personnel, as they, in the exercise of their profession and in their sole discretion, may deem necessary. I understand that I am responsible for all costs and expenses of such medial treatment. PUBLICITY AND MEDIA RELEASE I understand that photos of students taken during classes may be used in promotional materials and public relations programs created by Creative Groove Studio (CGS). I hereby authorize CGS to record the student's picture and voice in photographs, films, and tapes; to edit these recordings at its discretion; and to incorporate these recordings into videos used on CGS's website or social media pages. CGS is permitted to use these materials for publicity, advertising, and sales promotions. There will be NO identifying information included if photos or videos of your child are used. I further acknowledge that no promises of compensation has been made by CGS for said use.
Electronic Signature *
By selecting the "I Accept" checkbox and typing my name below, I am signing this agreement electronically. I agree this electronic signature is the legal equivalent of my manual signature on this agreement.
Please type your name to complete this agreement.