Which classes would you like to register for? *

Acrobatic Dance

Musical Theatre

Aerial Skills - Including Aerial Silk/Sling/Hoop/ Trapeze.

Circus Skills - Including Juggling, Hula Hooping, Poi & Ribbon Dance

Dance & Exam Prep 6+ - Including Ballet, Contemporary, Lyrical, Jazz & Modern

Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent Name *

First Name

Last Name

Phone *

(###)

###

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Emergency Contact *

Please provide an emergency contact. Please note this must be different to above contact details.

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Terms & Conditions *

Please note you are about to read and sign documents that could affect your legal rights. Please read all the information carefully and ensure all information is submitted accurately.

Participating in exercise classes, either online or in person, may involve inherent risks and hazards. I freely accept and fully assume all such risks, dangers, hazards and the possibility of personal injury, property damage or loss resulting in such risks/hazards. 

I voluntarily agree to release Vixen Dance & Fitness and Bella Statton from any and all liability for any loss, damage, injury or expense that I, my child, next of kin, successors or dependants may suffer or incur as a result of participation in either online or in person classes due to any cause including negligence on the part of Vixen Dance & Fitness or Bella Statton.

I understand that Vixen Dance & Fitness and Bella Statton will not assume responsibility for any lost or stolen property or for any bodily or personal injury consisting of or arising out of any participation in physical training.

By checking this checkbox I am confirming I have read and agreed to all of the policies and terms & conditions.

Photography & Videography *

Vixen Dance/Bella Statton may record/photograph exercises in classes for promotional purposes. These may be used on the website and or social media pages. Please opt in or out of your child being included in our photography/videography. You may change your mind at any time.

I consent to any and all photography & videography

I consent to photography & videography but not for the purpose of social media

I do not consent to any photography or videography

Physical Contact Consent *

At Vixen Dance we strive to ensure all children are training safely. Please read the following statements.

I agree that my child can participate in skills and be spotted by Bella Statton

I agree that in case of an emergency Bella Statton can perform emergency first aid on my child

I do not consent to my child to participating in skills that would require Bella Statton to spot them to ensure their training safely. I understand that this may mean my child is not allowed to participate in those skills.

I do not consent to my child receiving emergency first aid.

Waiver *

Please read the following statements. By ticking the following checkbox's I agree to the following statements.

This checkbox is a legally binding equivalent to my handwritten signature.

I will not at any future time, claim that my electronic signature is not legally binding or enforceable.

By ticking this checkbox and submitting this agreement I, acknowledge that I have read and fully understand all the policies and terms & conditions.

I voluntarily agree to be bound by this agreement. 

I can confirm I am at least 18 years old.

I can confirm that I am the parent/legal guardian signing this document on behalf of any minor under the age of 18.

By ticking this checkbox I represent that I have the authority to sign and enter into this agreement on behalf of the minor(s) listed above.

Clicking the submit button this checkmark applies to all sections and pages of this contract.

I understand that if I would prefer to sign a hard copy of this agreement, or have a copy of this agreement I need to contact Bella Statton at vixendanceandfitness@outlook.com