I am a parent/guardian wishing to enroll my child in Dimensions In Dance.

Dimensions In Dance/Dimensions On Stage
Parent Concussion Acknowledgment Form

Child's Name:
Date of Birth:
Sport/Activity: Dance/Acrobatics

What is a Concussion?
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Concussions can occur during sports, physical activities, or accidents.

Signs and Symptoms of a Concussion
Signs Observed by Others:

Appears dazed or stunned
Confusion about assignment or position Forgets instructions
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior, or personality changes

Symptoms Reported by the Athlete:

Headache or "pressure" in the head
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light or noise
Feeling sluggish, hazy, or foggy
Concentration or memory problems
Confusion

What to Do If a Concussion Is Suspected

Remove the child from play immediately.
Seek medical evaluation by a qualified healthcare professional.
Do not allow return to activity until cleared by a licensed healthcare provider trained in concussion management.
Follow the gradual return-to-play protocol under medical guidance.

Parent/Guardian Acknowledgment
I have received and read the information about concussions. I understand the signs and symptoms of concussions and agree to follow return-to-play policies to protect my child's health and safety.

Parent/Guardian Name:
Signature:
Date:

Release of Liability
I, the undersigned participant (or parent/guardian if participant is under 18), acknowledge that participation in dance classes, rehearsals, and related activities at Dimensions In Dance II Ltd / Dimensions On Stage Inc. involves physical movement that may result in injury. I understand and accept the risks involved, including but not limited to sprains, strains, falls, and other physical injuries.

By signing this form, I agree to release and hold harmless Dimensions In Dance II Ltd / Dimensions On Stage Inc., its owners, instructors, staff, volunteers, and agents from any and all liability, claims, demands, or causes of action arising out of or connected with participation in dance activities, whether on or off studio premises.

Medical Consent
In case of emergency, I authorize Dimensions In Dance II Ltd / Dimensions On Stage Inc. staff to administer first aid and/or seek emergency medical treatment for myself or my child. I understand that I am responsible for all medical costs incurred. If in the event of an emergency, parents will be notified.

Photo/Video Release
I hereby give Dimensions In Dance II Ltd / Dimensions On Stage Inc. permission to take photographs and videos of myself/my child during classes, events, and performances for use in promotional materials, social media, or the studio’s website.

☐ Check here if you do NOT consent to photo/video use.

Infectious Disease Waiver (Including COVID-19)
I acknowledge the contagious nature of COVID-19 and other infectious diseases and voluntarily assume the risk of exposure by participating in classes or events. I agree not to hold Dimensions In Dance II Ltd / Dimensions On Stage Inc. liable for any illness or injury resulting from such exposure.

Acknowledgment and Signature
I certify that I have read and understood this waiver and agree to the terms stated above.

Student's Name: ____________________
Date: ___________________

Parent/Guardian Signature (if under 18): __________________________________________
Date: ___________________

I understand that Dimensions In Dance requires a dress code for its classes and I agree to ensure my child is dressed safely and appropriately for dance class. This means no jewelry, jeans, oversized clothing or anything the teacher deems inappropriate for the style of dance. Correct footwear is a requirement for class and a student may be asked to sit out for their own safety if they are not wearing appropriate dance attire.

Cell phones, valuables, food and toys are not allowed in class. Please silence cell phones before entering the dance room. Dimensions In Dance is not responsible for any valuables left behind.

Tuition is paid monthly by the 10th day of every month. You may pay in cash or check at the studio up until the 10th day, thereafter your credit card will be charged your full tuition price plus a 3.25% convenience fee. A payment method must be kept on record for every account.

Tuition is due monthly regardless of attendance. If you choose not to come to class for any reason, you are still responsible for payment in full. We do not pro-rate classes for absences. Kindly notify the studio if your child will be absent.

Withdrawals from class must be emailed to the studio at DimensionsInDanceNY@gmail.com in order to not be charged the monthly fee.

Costume Deposits are due in November. We must receive a costume deposit in order to purchase a costume for the Recital. Once costume orders are placed, this deposit is non-refundable.

Costume Balances/Recital Fees are due in March. All costume balances/recital fees must be paid in full in order to receive a costume for your child's performance.

Thank you for your kind cooperation.