Email * Students Full Name * Students Date of Birth * Sex *MaleFemale Mailing Address * Cell # * Name & Relation of Emergency Contact# * Emergency Contact Phone # * Do you have asthma *YesNo Do you experience frequent nose bleeds? *YesNo Do you experience recurring sprains? *YesNo Do you have a heart condition *YesNo Do you experience severe allergic reactions? *YesNo Have you ever had a seizure? *YesNo Do you have any physical problems we should be aware of? * Do you have any disabilities we should know about * IF YOU HAVE ANSWERED "YES" TO ANY OF THE ABOVE PLEASE EXPLAIN BELOW: * Photo Release Form: I give Cre8ivity In Motion permission to use photos of me taken in class on Cre8ivity In Motions website, Facebook Page, Instagram and other social media platforms, in advertising as well as flyers and internal displays. I may recind this agreement by sending a letter. *Signature of Parent/Guardian: IF YOU HAVE ANSWERED "YES" TO ANY OF THE ABOVE PLEASE EXPLAIN BELOW: * Waiver: You agree that you are aware that you named above will be engaging in physical exercises involving coordination and fitness training which could cause injury. You agree that you, in voluntarily participating in these activities and assuming all risk of injury that may result, and you hold Cre8ivity In Motion, its officers, owners and employees harmless from all claims which may be brought against them for any such injury. *Signature of student: Tuition Policy: Tuition is paid either: A) prior to the beginning of class B) prior to the first class in a four week package. Cre8ivity In Motion will make every effort to accommodate scheduling makeups within this time frame as long as there is space available in the appropriate alternative class. *Signature of student: Holiday closures: Nov.25-28, Dec.23-Jan.2nd, April 11-17th, May 27-30th. Payments can be processed by Venmo: www.venmo.com/Cre8ivityinmotion (scanable QR code below for your convenience) or personal check made payable to "Cre8ivity In Motion". *Drop In $35/classAdult Classes (4 class pass)Private LessonPrivate Lesson Package
