Family Info

Parent/Guardian/Adult Student *

First Name

Last Name

Number of Participants *

1

2-3

3+

Environment *

Please tell us about the place you are providing for lessons to be held

Front Yard

Back Yard

Porch

Back Deck

Covered Driveway

Uncovered Driveway

* Other

Parent Present *

Do you plan on being present during the lesson

Yes

no

I have read and agree to all policies below *

Classes are designed for students/families that have been in quarantine together Family Provides designated outdoor space such as front/back lawn, front/back porch, driveway. Lessons will not be provided in ineligible spaces. Rain Policy: Summer showers will be monitored by the hour via radar. If a shower is shown to disrupt the lesson parents will be notified by phone one hour before a possible cancellation. Cancellations will be re-scheduled time permitting up until august 21st. Heat Index Policy: heat will be monitored hourly. If the heat index moves towards dangerous for outside activity parents will be notified by phone one hour before a possible cancellation. Cancellations will be re-scheduled time permitting up until august 21st. The instructor will maintain personal safety and can at any moment for any reason discontinue a lesson if safety precautions are not respected Parents/Adult participants must sign a waiver to take a class. Services will not be provided to participants without signed waivers Parents are encouraged to stay during lessons but are free to leave during the scheduled lesson Parents who return late will be subject to a late fee Late Fee Policy: all parents are welcome to a 5 minute grace period. After 5 minutes, $1 a minute charge will be added up until 10 minutes. After 10 minutes a $10 charge will be added. After two $10 late fee charges lessons will be unavailable for your family to book. Payment is due at the time of service. Forms of payment accepted are card, cash, or check. Card is preferred to maintain a contactless transaction, and checks can be made out to “ClayWorks.” Refund Policy: no refunds will be issued for services rendered

Yes

No

I accept the liability waiver *

By signing this waiver, I am releasing Vania Claiborne/Clayworks from all liabilities associated with injuries sustained during dance lessons in any form or related offerings. I am aware that dance is a physical activity that carries the risk of injury and will proceed with caution. I will consult with a physician before proceeding if I have health risks.

Yes

No

I accept the photo release *

“I understand that lessons may be photographed and/ or filmed and assign the right to photograph me and/or my child/ward, and to use my or his/her picture, image, silhouette, or likeness, for the exclusive use of Vania Claiborne/Clayworks on her official websites, social media, or in any publications. I understand that neither I nor my child/ward will receive compensation for this use. I understand this release will not expire. I understand that if I do not agree to this waiver, my wishes will be respected, and I will not be disqualified from taking lessons."

Yes

No

Liability/Photo Release Signature *

By signing below you acknowledge you read and accept the liability waiver & photo release waiver

First Name

Last Name