Blueprint Dance Company

After-School Program Registration & Consent Form

Child Information

Health and Emergency Information

While students are supervised by school staff during the after-school program, Blueprint Dance Company collects the information below to support student safety during dance instruction and in the event of an incident.

Please share any medical conditions, injuries, or health concerns that may impact your child’s ability to participate safely in dance activities. This information helps instructors provide appropriate modifications when needed.

Please Note: In the event of an injury or medical concern, Blueprint Dance Company instructors will follow first aid procedures, notify school staff immediately, and complete an incident report. Emergency contact information is collected for support purposes only and does not replace the school’s emergency protocols.

Liability & Participation Waiver

Please read carefully before signing.

I, the undersigned parent/guardian, give permission for my child to participate in the Blueprint Dance Company After-School Program. I understand that dance activities involve physical movement and inherent risks, including but not limited to falls, collisions, muscle strain or injury.

I agree that:

1. I understand and voluntarily assume all risks associated with my child’s participation in the program.

2. I will not hold Blueprint Dance Company, its staff, instructors, volunteers, or affiliated schools responsible for any injury, accident, or illness that may occur during or as a result of participation.

3. My child will follow all safety instructions and program rules provided by instructors and school personnel.

4. Blueprint Dance Company reserves the right to modify or pause participation, or remove a student from class, if their behavior or physical condition poses a risk to themselves or others.

5. I have disclosed all relevant medical conditions and injuries that may impact participation.

6. I authorize emergency medical treatment if necessary and understand that reasonable efforts will be made to contact me or the emergency contact listed.

   
   

By signing below, I acknowledge that I have read, understand, and agree to this waiver.

Media / Photo Release

Blueprint Dance Company loves celebrating student growth, creativity, and joy through dance. From time to time, photos or videos may be taken during after-school classes to highlight student progress, class activities, and program experiences.

By signing below, I grant Blueprint Dance Company permission to photograph and/or record my child during dance activities for professional, appropriate use, including:

• Program updates and progress sharing

• Marketing and promotional materials

• Blueprint Dance Company website and social media platforms

  
  

All media will be used respectfully and thoughtfully, with student safety and dignity as a priority. Blueprint Dance Company will never post content that is inappropriate, misleading, or unsafe.