Center Street Dance Academy

Everyone deserves to dance

Register for Classes

Parent Name *
Parent Name
Cell Phone *
Cell Phone
Name of Person to be Invoiced *
Name of Person to be Invoiced
Write the name of the person you would like to receive the invoice for you or your child's class.
For the following, only fill out information for the number of children you'll be enrolling. NO students younger than 3 years will be admitted to any class.
Child #1
Child #1
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Child #3
Child #3
Select which class you would like to enroll your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Child #4
Child #4
Select which class you would like to enroll your child in.
Select which class(es) you are enrolling your child in.
Select which class(es) you are enrolling your child in.
Media Release
I give my permission to the Center Street Dance Academy to use images of my child(ren) in photos, videos or other digital media in any and all of its publications, including web-based distribution and advertisements, without payment or other consideration. I understand and agree that all photos and videos will become the artistic property of the Center Street Dance Academy. I authorize Center Street Dance Academy to edit, copy, publish or distribute these photos for any lawful purpose. In addition, I waive the right to inspect or approve the finished product wherein the likeness of my child(ren) appears. I waive any right to royalties or other compensation arising or related to the use of the photo. I also give Center Street Dance Academy permission to utilize my child's name in correlation with their image if he/she so decides. I retain the right to have any photographs discontinued from use in any or all of the above venues upon request, but understand that it is my responsibility to contact the program director to make this request.
Release of Liability *
1. I HEREBY RELEASE THE CENTER STREET DANCE ACADEMY, ITS AGENTS, VOLUNTEERS, EMPLOYEES AND ASSIGNS FOR ANY DAMAGES, LIABILITY, OR COSTS RESULTING FROM AUTHORIZING MEDICAL TREATMENT ON MY/MY CHILD'S BEHALF UNDER THE TERMS OF THIS AGREEMENT. 2. I FURTHER RELEASE CENTER STREET DANCE ACADEMY FROM ANY COSTS, DAMAGES OR EXPENSES INCURRED AS A RESULT OF ANY CLAIM, OR ACTION FILED BY ANY PARTY ALLEGING DAMAGES AS A RESULT OF ANY MEDICAL TREATMENT PROVIDED, OR AUTHORIZATION FOR TREATMENT PROVIDED WHILE PARTICIPATING AT CENTER STREET DANCE ACADEMY. I UNDERSTAND THAT THIS IS A RELEASE OF INDEMNIFICATION FOR CENTER STREET DANCE ACADEMY AND ITS AGENTS, VOLUNTEERS, EMPLOYEES OR ASSIGNS REGARDING THE ABOVE STATED RELEASE OF LIABILITY. 3. I AM AWARE THAT INJURY, OR ILLNESS MAY OCCUR WHILE ATTENDING CENTER STREET DANCE ACADEMY AND THAT SUCH ILLNESS AND INJURY MAY RESULT IN INCURRING COSTS, EXPENSES, AND DAMAGES FOR WHICH I (THE PARENT) AM SOLELY RESPONSIBLE, AND WILL BE HELD LIABLE FOR ANY COSTS SPENT TO TREAT MY CHILD, INCLUDING ANY TRANSPORTATION COSTS. 4. I HEREBY RELEASE CENTER STREET DANCE ACADEMY, ITS EMPLOYEES, AND REPRESENTATIVE/VOLUNTEERS FROM ALL LIABILITY FOR PERSONAL INJURY, INCLUDING DEATH, AS WELL AS ALL PROPERTY DAMAGE OR LOSS ARISING OUT OF MY/MY CHILD'S PARTICIPATION IN THIS CAMP AND TRANSPORTATION TO AND FROM THIS PROGRAM. 5. I ALSO GIVE CENTER STREET DANCE ACADEMY THE RIGHT TO USE MY/MY CHILD'S PICTURE OR VOICE IN A DIGNIFIED FASHION. IF THERE IS AN IMAGE AND/OR VIDEO THAT THE FAMILY DOES NOT WANT USED FOR PROMOTIONAL PURPOSES, UPON CONTACT, WE WILL PROMPTLY REMOVE THE IMAGE AND/OR VIDEO.

CENTER STREET DANCE ACADEMY, 401 CENTER STREET, NASHVILLE, TN 37138 707.360.5317 INFO@CENTERSTREETDANCE.COM