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2021-2022 Adult Virtual Dance CAC Registration

Tell us about yourself

1. Please tell us about the participant.
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4. Do you have an Edmodo account? *This question is required.
6. Have you ever taken a dance or creative movement class? *This question is required.
7. Where did you hear about this class? *This question is required.
8. Release of liability, waiver of claims, assumption of risks, indemnity agreement, and media release
Please check the appropriate box below indicating you agree or do not agree with the statement. Please note- you/your child will NOT be able to participate in the program if you check "I do not agree" to item 1.
  *This question is required.
1) Release of liability- 
I agree to the following release of liability as a participant or parent/guardian of a participant in an in-person and/or online program with Arts4All Florida. In the case of any injury to registrant associated with an activity involving Arts4All Florida, the registrant shall indemnify and hold harmless, and hereby release, discharge, and acquit Arts4All Florida (and their respective directors, officers, members, employees, agents, teaching artists, and independent contractors) from and against any and all claims, damages and liabilities resulting from or associated with said injury or the treatment of said injury. By checking "I agree" and signing this in the area below release, I acknowledge I have read and fully understand this agreement and intend my signature to be an unconditional and complete release of all liability. I also acknowledge that my electronic signature has the same force and effect as an original signature. *This question is required.
2) Media release-
I hereby give consent to Arts4All Florida to use my/my child's first name, photo, voice, or other likeness that is included in virtual programming as well as artwork created in the program for future public awareness including print media, online news distribution, Arts4All Florida website, television and radio opportunities, video, promotional materials and other similar mediums (the "Production"). Such use of the Production is permitted throughout the world or exhibition purposes by Arts4All Florida in whatever manner it may desire, and may be copied, copyrighted, edited and distributed by Arts4All Florida in any medium in perpetuity without any compensation to me.  Furthermore, I consent that any such Production shall be the exclusive property of Arts4All Florida and Arts4All Florida shall have the right to use, sell, publish, print, display, distribute, duplicate, reproduce, reprint, create derivative works, and make other uses of such Production as Arts4All Florida may desire, free and clear of any claims whatsoever on my part. 
  *This question is required.
9. By signing this release, I acknowledge I have read and fully understand the policies above and have selected "I agree" or "I do not agree" for each one. I acknowledge that my electronic signature has the same force and effect as an original signature. *This question is required.
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10. This program is provided free of charge thanks to the generosity of our donors and sponsors. You can help Arts4All Florida continue to provide community art classes by making a donation. Thank you for supporting us and our Teaching Artists!
THANK YOU FOR YOUR DONATION. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE.  REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. OUR REGISTRATION NUMBER IS CH8088.
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