Registration and Liability Waiver Form

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AAkriti Kathak Academy - Please fill out for each student

Student's Full Name *

Whatsapp Contact number *

Email Address *

Student's Date of Birth *

YYYY

Address *

City *

Zip Code *

Parent's Full Name *

Primary Contact number *

Please list any allergies or medical conditions we should be aware of *

Please select your class *

Beginners Level 1 Sun 2 pm

Beginners Level 1 Wed 8 pm

Prarambhik Level 2 Sunday 9 am

Praveshika Level 2 Monday 5:30 pm

Praveshika Level 2 Monday 6:30 pm

Praveshika Level 3 Tuesday 5:15 pm/Sunday 5

NEW Praveshika Level 3 7:45 pm Mon/ 7 pm Wed

Madhyama Level 4 Mon/Wed 10:00 am

Madhyama Level 4 Tuesday 6 pm/Sun 3

Madhyama Level 5 Sunday 12 Noon/Tue 7:30

Visharad Level 6 Sunday 10 am

Visharad Level 7 Wednesday 6 pm/Sun 4

One on One Lesson

Release of Liability *

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for registered student’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: AAkriti Kathak Academy, NAACHMASALA school of dance and KRITI RAKESH and/or their directors, officers, employees, volunteers, representatives, and agents

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE AAkriti Kathak Academy, NAACHMASALA School of Dance and/or KRITI RAKESH BHATIA from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

Electronic Signature. Please print your name below *

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