Dancers Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Parent/Guardian

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian

First Name

Last Name

Phone

(###)

###

####

Emergency Contact/Authorized For Pick Up

First Name

Last Name

Phone

(###)

###

####

Waivers

Medical Waiver - I understand that in the event of an accident or illness involving my child, Fayez1 staff will make every attempt to contact me and/or my partner. If, however, I or my partner cannot be reached, I hereby give Sprouts – Growing Bodies & Minds, Sprouts Maker Space & Fayez1 Dance Academy and its entire staff the authority to act on my behalf.

Illness Policy - I understand that my child cannot attend dance if they are ill, and I will be required to pick them up immediately should they be ill upon arrival.

Photographic Waiver - I give permission for my child's photograph to be taken and used for Fayez1 Dance web/social media purposes..

Date

MM

DD

YYYY