Studio Registration - Fee Waiver - Kansas City Friends of Alvin Ailey

Parent/Guardian Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Number of Students Registering*

1 student
2 students
3 students

Student #1*

First Last

Date of Birth*

Age*

Gender*

Female
Male

School Name*

Current Grade*

District*

Student #2

First Last

Date of Birth

Age

Gender

Female
Male

School Name

Current Grade*

District

Student #3

First Last

Date of Birth

Age

Gender

Female
Male

School Name

Current Grade*

District

Emergency Contact Info

Emergency Contact (Other than Parent/Guardian #1)*

First Last

Emergency Contact Phone*

Emergency Contact Relationship to Student*

Demographic Info

Please select for Student #1:*

KCFAA serves youth of all races. For reporting purposes, it is helpful to identify the ethnic origin of our campers. Indicate which best describes the student.

African American
Hispanic
Caucasian
Asian
Native American
Multiracial
Other

Please specify

Please select for Student #2:

KCFAA serves youth of all races. For reporting purposes, it is helpful to identify the ethnic origin of our campers. Indicate which best describes the student.

African American
Hispanic
Caucasian
Asian
Native American
Multiracial
Other

Please specify

Please select for Student #3:

KCFAA serves youth of all races. For reporting purposes, it is helpful to identify the ethnic origin of our campers. Indicate which best describes the student.

African American
Hispanic
Caucasian
Asian
Native American
Multiracial
Other

Please specify

For grant purposes, it is helpful to identify the household income of our participants. Kindly indicate which best describes you:*

Number in household*

Please enter a number from 1 to 8.

Free/Reduced School Lunch?

Yes
No

Releases and Waivers

CONSENT AND RELEASE

I hereby waive and release KCFAA and its officers, agents, volunteers and employees from all acts or omissions resulting in any physical injuries, medical treatment, or other damages to myself or any minors of whom I am parent or legal guardian, resulting from participation in KCFAA programs. I further waive and release KCFAA and its officers, agents, volunteers, and employees from any damages sustained by the aforementioned or any guests of the aforementioned as a result of any condition, act, omission or accident on or at 1714 East 18th Street, Kansas City, MO 64108 or any other premises upon which any activity related to KCFAA takes place. This release is granted in perpetuity. I agree to the above and have read the policies and procedures and agree to abide by the terms and conditions therein.

PHYSICAL ACTIVITY CONSENT

I have enrolled my child/children in a program of strenuous physical activity, offered by KCFAA. I hereby affirm that I am or the above person is in good physical condition and does not suffer from any disability that would prevent or limit participation in this dance program. In consideration of myself, my heirs and assigns, hereby release the KCFAA, from any claims, demands, and causes of action arising from my or the above named person’s participation in any of the above stated programs, and I hereby release the KCFAA from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls, tears, broken bones, shin splints, heat prostration, knee, lower back, or foot injuries and any other illness, soreness or injury however caused occurring before, during or after participation in any other of the programs offered at KCFAA or at any time, while in the vicinity of the premises of the above stated business, or in any activity sponsored, represented, or organized by KCFAA, for any reason. By signing, I hereby affirm that I have read and fully understand and agree with the above waiver.

PHOTOGRAPHIC RELEASE

I agree that my child’s picture or likeness can be represented and published in KCFAA publication/media or publication/media authorized by KCFAA.

KCFAA STUDIO PROGRAMS INFORMATION GUIDE

I agree that I am responsible for obtaining and reading a copy of the KCFAA Studio Programs Information Guide.

ONLINE CYBER SECURITY/SAFETY

Parent/Guardian Responsibilities: represented and published in KCFAA publication/media or publication/media authorized by KCFAA.

Monitor Student Use: The parent/guardian must agree to monitor student use at home. The best way to keep students safe and on-task is to have a parent/guardian present and involved. Suggestions include: · Investigate and apply parental controls available through your Internet service provider and/or your wireless router. · Develop a set of rules/expectations for computer use at home. Don’t forget rules for social networking, instant messaging, e-mailing, online gaming and using webcams. · Only allow non camp computer use in common rooms of the home (e.g., living room or kitchen) or other high traffic areas and not in bedrooms. · Demonstrate a genuine interest in what your student is doing on the device. Ask questions and request that they show you his or her work often. · Continually dialogue with your children about online safety. Student Online Safety Parents should take precautions to help students be safe online. Suggestions include: · Help your children understand what information should be private and not shared when surfing the web. · Explain that children should post only information that you – and they – are comfortable with others seeing. · Go where your child goes online or follow your child online. Teach your child to recognize and report: · Cyberbullying · Online predators · Exposure to inappropriate materials Visit http://www.netsmartz.org/Parents or other online sites with information on how parents can ensure their child’s safety online. PARENT/GUARDIAN UNDERSTANDING I am enrolling my child/children for KCFAA Studio Programs. I understand that all registration fees must be paid. By signing this form, the parent/adult is assuming any and all responsibility for the student(s), including financial obligations. The parent/adult signing below has also received a copy of the studio policies, and has read and understands all policies. I have read the above consent and release waivers and agree to abide by all terms and conditions.*

Electronic Signature*

I have read the above consent and release, physical activity, photo release, studio program guide, online security waivers and agree to abide by all terms and conditions. Additionally, my typed name will serve as my electronic signature.

STUDIO PROGRAM REGISTRATION

2020 Studio Dance Registration and Enrollment Form

Emergency Contact Info

Demographic Info

Releases and Waivers