Scholarships — GROOVEBOX INC

Please complete the form below to activate your child’s scholarship! Your free month(s) start when we receive your registration!

Dancer's Name

First Name

Last Name

Dancer's Age

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone #

(###)

###

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What classes is your dancer interested in?

Ctrl + Click to choose multiple!

Funk Styles

Femme Styles

Breaking

Hip Hop

Foundation First

Animation + Robot

Street Styles

Youth Hip Hop

Participation Waiver

As the legal guardian of my designated student(s), I recognize that potentially severe injuries can occur in any activity involving height or motion, including tumbling and related activities including dance and physical activity in general. I understand that it is the express intent of all staff and personnel to provide for the safety and protection of my student(s) and, in consideration for allowing my student(s) to use these facilities, I hereby COVENANT NOT TO SUE and FOREVER RELEASE this facility, affiliated and partner companies and organizations, property owners and lessors, staff, contractors, subcontractors, teachers, coaches, owners, directors and other members involved in this facility's program(s), from all liability and for any and all damages and injuries suffered by my student(s) during instruction, supervision, and/or control during any and all classes or extra activities. We will do our best to ensure the safety of the dancers and their guardians. Due to the physical nature of dance, Groovebox Studio as a whole will not be held responsible for any injuries that may occur inside or outside the premises or at home. By consenting below, I hereby release and agree to hold my son/daughter harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the Groovebox Studio, or that may otherwise arise in any way in connection with any services received from the client. The waiver also includes a Photo and Video Release which means that you agree to the use of images of you or your child by Groovebox Studio on the website, social media pages, in brochures or in other promotional materials. No identifying information will be included.

Consent

I have read and understood the above waiver and consent to the student's participation in this facilities programs.

I Consent

Any questions or concerns?

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GROOVEBOX INC.