Registration

All participants must be registered before participating in classes, workshops and performances.  Sample registration forms follow:

REGISTRATION PACKET FOR DANCE STUDENTS UNDER AGE 18
If you are under the age of 18, these forms need to be filled out by a parent or legal guardian.
NO STUDENT WILL BE ALLOWED TO PARTICIPATE IN CLASSES, REHEARSALS, WORKSHOPS, ETC. UNTIL THE FOLLOWING PAGES ARE FILLED OUT, SIGNED, AND DATED.
name___________________________________________________________
birth date _______________________________________
parents name______________________________________________
address _____________________________________________________
phone _________________________ email __________________________
parents name______________________________________________
address _____________________________________________________
phone _________________________ email __________________________
emergency contacts and phone number___________________________________________________________
_______________________________________________________________
Please use the Emergency Medical Release form for more emergency information.
Please sign and date the Hold Harmless Agreement.
Please fill out the Permission to Participate form.
Please fill out the Photo Release and other forms.
Thank you, Katherine Wolman po box 1060 Redway, CA 95560 kwolman@asis.com sohumdancing.com

HOLD HARMLESS AGREEMENT
Please read, sign and date:
I agree to hold harmless from any and all liability, the school, Katherine Wolman, SoHum Dancing, The Feet First Dancers, Redwood Playhouse, and David Katz Enterprises, and their officers, agents and employees, in both a professional and personal capacity, against any and all injuries, illnesses, costs, losses, damages and expenses ( including attorney fees) which I or my child, might suffer while participating in any classes, productions, workshops, or events of any kind connected to the dance and exercise program.
By signing this agreement, I understand that I am waiving the right to any claims, pleas, demands, or causes of action which I may now, or in the future, possess against the above named parties that might arise out of participating in, or are related to participating in, the above listed activities.
Children under 18
child’s name___________________________________________________
parent’s or guardian’s signature____________________________________
date__________________________________________________________
parent/ guardian name______________________________________________
address _____________________________________________________
phone _________________________ email __________________________
PERMISSION TO PARTICIPATE
My child,_______________________________________________________ has permission to participate in classes, performances, workshops and other related events, as a student of Katherine Wolman, SoHum Dancing, and as a member of The Feet First Dancers. These activities may take place at, but are not limited to, locations outside of the studio, such as Redwood Playhouse, Mateel Community Center, Garberville Town Square, Benbow Lake State Park, or local schools. Parents will be notified in advance of these activities.
Print name________________________________________________
sign_______________________________________ date_____________
USE OF PREMISES
FOR CHILDREN UNDER 12
I understand that all students under the age of 12 are not allowed to leave the premises of these activities without being accompanied by a parent, guardian, or other adult previously arranged with the teacher.
Please sign_________________________________
I understand that all students under the age of 12 are not allowed access to the costume storage room that is upstairs, unless accompanied by a parent, guardian, teacher, or other adult involved with the program
Please sign____________________________________________
FOR STUDENTS 12 AND OVER
Students aged 12 and older require written permission to leave the premises on their own, after notifying the teacher, or other adult in charge, that they are leaving. They may leave during daylight hours only, for a specified location. After dark, all students must be accompanied by an adult when leaving unless they are permitted to drive alone.
My child has permission to leave the premises on their own, during daylight hours, after notifying the teacher, or other adult in charge.
Please sign______________________________________________
Students 12 and over may have access to the costume storage room that is upstairs, on occasion. They are NOT allowed to bring any child under the age of 12 with them, without an adult.
My child has permission to access the costume room upstairs without an adult.
Please sign______________________________________________
Students 12 and over may have use of the public atrium area unsupervised, as long as they behave in a manner that is respectful to others.
My child has permission to use the public atrium area of the building, unsupervised.
Please sign________________________________________________
PUBLICITY AND PHOTO / VIDEO / MEDIA RELEASE
Katherine Wolman, SoHum Dancing, The Feet First Dancers, and Redwood Playhouse occasionally submit media material to local newspapers, the SoHum Dancing facebook page, and sohumdancing.com to publicize their events.
My child may appear in these photos__________________________________
My child MAY NOT appear in these photos_____________________________
Child’s name_______________________________________________________
Please sign_________________________________ date __________________
At the present time we do not have a policy in place regarding internet posting of photos and videos made by family and friends of dancers. Please be considerate of our young community members when making such posts. Thank you.

SoHum Dancing is developing a tradition of publishing calendars of studio related activities and videos of performances that will be available to all dancers and their families. All effort will be made to present all students in a positive and healthy manner.
My child, ________________________________________________________ has permission to appear in these projects.
___________________________________________________________________
Parent/guardian signature date
PHYSICAL CONTACT
Teaching dance is a physical activity that may involve hands-on contact to make corrections or assist the learning process. This contact will be done in a manner that honors and safeguards the well- being of each student. Please let us know if there are any concerns specific to you or your child.
Signature__________________________________ date ____________________

EMERGENCY MEDICAL RELEASE
I grant permission to Katherine Wolman or an adult who is part of the school’s program to take first aid measures as judged necessary for the care and protection of my child in the event of a medical emergency. In such an event, I understand that my child may need to be transported by a local emergency unit to the nearest medical facility if the emergency unit deems it necessary. I understand that the emergency unit may need to be contacted before the child’s parent, guardian, other designated adult or physician can be reached. I also agree to be responsible for any expenses that may be incurred in such an emergency.
Child’s name__________________________________________________
birth date______________________________________________________
any known allergies to medication ___________________________________ _________________________________________________________________
other allergies _____________________________________________________ _________________________________________________________________
any medical condition that could affect my child’s ability to participate in a potentially strenuous activity ___________________________________________________________________________________________________________________________________________
Medical emergency contacts, names and numbers
parent / guardian_____________________________________________________
parent / guardian____________________________________________________
other family member or friend____________________________________________
doctor________________________________ phone #_____________________
dentist _________________________________phone #____________________
preferred medical facility__________________________________________________
insurance__________________________________________________________
parent / guardian signature ___________________________________________ date______________
REGISTRATION FOR ADULT PILATES STUDENTS
If you are aged 18 or over, please fill out the following form before attending class.
name______________________________________________________
mailing address_____________________________________________
phone numbers ________________________________________________
email ______________________________
emergency contacts and phone numbers______________________________________________________________________________________________________________________
Please list any injuries or illnesses that could affect your ability to perform pilates exercises:____________________________________________________________________________________________________________________________
Goals of your pilates program:______________________________________________________________
Other forms of exercises that currently you do: ________________________________________________________________

HOLD HARMLESS AGREMENT
I agree to hold harmless from any and all liability, the school, Katherine Wolman, SoHum Dancing, Islay Dillon-Ogden, Alisa Dillon –Ogden, and David Katz Enterprises and their officers, agents and employees, in both a personal and professional capacity, against any and all injuries, illnesses, costs, losses, damages and expenses (including attorney fees) which I might suffer while participating in the pilates exercise program. By signing this agreement, I understand that I am waiving my right to any claims, pleas, demands, or causes of action which I may now, or in the future, possess against the above named parties that might arise out of participating in pilates activities.
Print name_________________________________________
signature__________________________________________ date _________

REGISTRATION FOR ADULT DANCE/EXERCISE STUDENTS

If you are aged 18 or over, please fill out the following form before attending class.
Name _________________________________________________
Mailing address ____________________________________________________
Phone ___________________________________________________________
email ___________________
emergency contacts and phone numbers:
_____________________________________________________________________________________________________________________________
Please list any injuries or illnesses that could affect your ability to participate in a dance class: _______________________________________________________________________________________________________________________________
Other forms of dance or exercise that you are currently participating in _____________________________________________________________

HOLD HARMLESS AGREMENT
I agree to hold harmless from any and all liability, the school, Katherine Wolman, SoHum Dancing, Feet First Dancers, Redwood Playhouse, and David Katz Enterprises and their officers, agents and employees, in both a personal and professional capacity, against any and all injuries, illnesses, costs, losses, damages and expenses (including attorney fees) which I might suffer while participating in the dance and exercise program. By signing this agreement, I understand that I am waiving my right to any claims, pleas, demands, or causes of action which I may now, or in the future, possess against the above named parties that might arise out of participating in exercise and dance activities.
Print name_________________________________________
Signature __________________________________________ date ___________
SIZING INFORMATION FOR COSTUMES
CHILDS’S NAME ___________________________________________________
AGE ____________ DATE _____________________
PARENTS NAME ______________________________
CONTACT NUMBER __________________________
Height _______________
Bust/ chest _______________
Waist ___________________
Hips ____________________
Girth ____________________
Inseam _________________
Street shoe size _____________
Costume size based on charts ___________
Type of costume (may affect size choice) _________

Revolution Dancewear sizing and measurement charts
Sizing Suggestions & Helpful Hints
• We suggest you measure your students while they are wearing a leotard for the most accurate measurements.
• When trying to decide which size to order, girth should be the most important measurement.
• Take into account that young children will grow throughout the year.
• Our XLC and XXLC sizes are made to fit a larger child, not a petite adult.
• Purchase our Costume Sizing Kit for extra help and better accuracy!

• Bust/chest: Measure across the back and around the fullest part of the bust ______________
• Waist: Measure around the natural waist ________________
• Hips: Measure around the widest part of the hips ________________
• Girth: Measure from the center of one shoulder, down through the crotch, and back up to the same shoulder ________________
• Inseam: Measure from the crotch down to the ankle bone on the inside of the leg______

Shoe size___________

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