Student Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian Name *

First Name

Last Name

Emergency Contact Number *

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AGREEMENT: I, the undersigned, hereby forever release, discharge, & acquit LA ESTABLISHMENT, including all their employees, teachers, and agents, from any and all claims for damages or injuries of any kind, nature or description, resulting from NYC REMIX JUNIOR INTENSIVE. This expressly includes, but is not limited to, any injury or damage caused by or resulting from the negligence of LA ESTABLISHMENT, employees, teachers, agents, etc. I acknowledge the fact that certain types of injuries are common & inherent in dance-related activities. This release includes but is not limited to that type of injury. This release shall be binding upon & inure to the benefit of the parties, their successors, assigns & personal representatives. I understand that all Choreographers, teachers and performers automatically grant permission to LA ESTABLISHMENT to use their photos and videos for advertising and publicity purposes, inclusive of television, internet, videotaping, or film broadcast in connection with promotional campaigns. *

I agree

AGREEMENT: I understand that to complete my registration, I must complete payment of $595 using the link I am given upon acceptance of my application I understand my spot will not be solidified until receipt of payment. I understand that all payments towards MSA Educate events are non-refundable, but fully transferable in the case I cannot participate in the event originally intended. *

I agree.