Child registration form

Email*

Students Full Name*

Students Date of Birth*

Sex *MaleFemale

Parent / Guardian Name*

Parent / Guardian Number*

Mailing Address*

Cell #*

Name & Relation of Emergency Contact*

Emergency Contact Phone*

Does your child have asthma?*YesNo

Does your child experience frequent nose bleeds?*YesNo

Has your child ever dislocated a joint?*YesNo

Does your child experience recurring sprains?*YesNo

Does your child have a heart condition?*YesNo

Is your child taking any medications?*YesNo

Does your child have vision or hearing loss?*YesNo

Does your child experience severe allergic reactions?*YesNo

Has your child ever had a seizure? *YesNo

Does your child have any physical problems we should be aware of?*

Does your child have any fears we should know about?*

Does your child have any disabilities we should know about?*

Does your child have any sensory issues their instructor 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 my child 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:

Waiver: You agree that you are aware that your child named above will be engaging in physical exercises involving coordination and fitness training which could cause injury to them. You agree that your child in voluntarily participating in these activities and assuming all risk of injury that may result, and you hold Cre8ivity In Motion, Cool Hot Yoga, Tenafly Arts, its officers, owners and employees harmless from all claims which may be brought against them for any such injury.*Signature of Parent/Guardian:

Tuition Policy: Tuition is paid either: A) at the beginning of an 6 or 8 week intensive session or B) at the beginning of the Semester. The Dance Program is separated by 2 Semesters: Semester I: Sept - Jan / Semester II: Feb -June or C) The beginning of any Dance Intensive. * I understand that tuition is not refundable. Make up classes for any classes missed by the student must be made up within the session, semester or intensive. Makeup classes will not be carried over to a new session, semester or intensive. 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 Parent/Guardian:

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