Movement Arts for Tots Registration

Movement Arts for Tots Registration

Register your child for a playful movement series designed for ages 12–36 months. Parent or caregiver participation is required for all classes.
Child Name

First NameLast Name
Child Age (months)
Child Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent Email
example@example.com
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Parent/Guardian Name (optional)

First NameLast Name
Additional Parent Email (optional)
example@example.com
Emergency Contact Name

First NameLast Name
Relationship to Child
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Alternate Phone Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any allergies?
If yes, please describe.
Does your child have any medical conditions, developmental considerations, sensory sensitivities, or mobility limitations that may affect participation?
Any additional information you would like the instructor to know?
Registration Type
If registering for your 1st drop-in session, select the class date you are interested in.
Attendance & Makeup Policy: Due to limited enrollment and studio scheduling commitments, refunds and individual makeup classes are not available for missed classes. In the event that Amanda Marie Training must cancel a class, a makeup session or credit will be provided.
Participation Waiver & Release of Liability
I, the undersigned parent or legal guardian of the participant listed in this registration form, acknowledge and understand that participation in Movement Arts for Tots and related movement education programming involves physical activity and inherent risks, including but not limited to falls, collisions, minor injuries, illness, and other risks associated with movement activities, sensory play, balance and coordination exercises, and parent-child participation. I certify that the participant is physically able to participate in these activities and agree to disclose any relevant medical conditions, allergies, developmental considerations, or physical limitations that may affect participation. I understand that Amanda Marie Training will take reasonable precautions to promote a safe and supportive environment; however, I voluntarily assume all risks associated with participation. In consideration for participation in this program, I hereby release, waive, and discharge Amanda Marie Training, Amanda Bernett, studio rental facilities, assistants, contractors, and affiliates from any and all liability, claims, demands, actions, or causes of action arising from injury, illness, loss, or damages related to participation in the program, except in cases of gross negligence or willful misconduct.
The following selection serves as my agreement/signature for Liability Waiver acknowledgement.
Emergency Medical Authorization
In the event of illness or injury requiring emergency medical treatment, I authorize Amanda Marie Training and its representatives to obtain emergency medical care for the participant if I cannot be reached immediately. I understand that I am financially responsible for any resulting medical expenses.
The following selection serves as my agreement/signature for Emergency Medical Authorization.
PARTICIPATION WAIVER & RELEASE OF LIABILITY
Photo & Video Release Preference
Parent/Guardian Name

First NameLast Name
EMERGENCY MEDICAL AUTHORIZATION
Parent/Guardian Electronic Signature
Date

MonthDayYear
Date

Payment / Registration

Full 5-Week Series

$175.00

Single Drop-In Class

$40.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Movement Arts for Tots Registration

Participation Waiver & Release of Liability

Emergency Medical Authorization

Payment / Registration*

Payment / Registration