As you are aware, dancing involves a range of motion that is often not performed outside of class or performance. Dancers may be susceptible to sprains and strains as part of their normal dance experience. Some individuals may have previous injuries that make them susceptible to further injuries and should therefore inform Janice D. Holst of such. Students are ultimately responsible for recognizing and adhering to any limitations that are a result of previous injury. Janice D. Holst will not be held responsible for injuries that may occur under her supervision. All studio equipment shall be used/treated in the proper way it is intended, i.e. do not hang on the dance bars, do not touch the mirrors, and stay away from the stereo equipment. Security at the VFW cannot be guaranteed so please leave valuables and anything unnecessary for class at home. Janice D. Holst is not responsible for any lost or stolen items. Students should be present at the VFW only for their appropriate class (es).
Signature of Parent/Guardian: _________________________________ Date: ______________
Contact Phone: Home: ________________ Work: ________________ Cell: _______________
If I cannot be reached in the event of an emergency, the following
person is authorized to act on my behalf:
Name: _____________________________________ Phone:
H____________ W__________
Address: _____________________________________________________________________
Family Physician: ___________________________________ Phone: ____________________
Janice D. Holst is authorized to give permission to appropriate
medical or hospital personnel to provide emergency medical or surgical care for
(student's name) _________________________ in the event that I cannot be
contacted immediately. It is understood
that a conscientious effort will be made to locate me or my child's other
parent or legal guardian before any action will be taken. I will assume the cost of necessary medical
or surgical care.
Signature of Parent/Guardian: _________________________________
Date: ______________
The student has the following pre-existing medical conditions that
Janice D. Holst should be aware of.
Please note the nature of the condition and instructions, if any, that
should be followed in detail below:
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