KCFAA Master Class Series - Kansas City Friends of Alvin Ailey

Your Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Number of Students*

Student Name*

First Last

Student Age*

Number years of dance training*

Student 2 Name*

First Last

Student 2 Age*

Student 2 Number years of dance training*

Student 3 Name*

First Last

Student 3 Age*

Student 3 Number years of dance training*

Class Selection

Tue 6/19
Thu 6/21
Tue 6/26
Thu 6/28
Wed 7/3
Thu 7/10
Tue 7/12
Thu 7/17
Tue 7/21

Number of Classes*

10 Classes - $105.00 ea.
7 Classes - $87.50 ea.
1 Class & Walk-ins - $20.00 ea.

Total

Credit Card

American Express

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MasterCard

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Card Number Expiration Date Security Code Cardholder Name

KCFAA CONSENT AND RELEASE
I hereby waive and release KCFAA and its officers, agents, volunteers and employees from all acts or omissions resulting in any physical injuries, medical treatment, or other damages to myself or any minors of whom I am parent or legal guardian, resulting from participation in KCFAA programs. I further waive and release KCFAA and its officers, agents, volunteers, and employees from any damages sustained by the aforementioned or any guests of the aforementioned as a result of any condition, act, omission or accident on or at 1714 East 18th Street, Kansas City, MO 64108 or any other premises upon which any activity related to KCFAA takes place. This release is granted in perpetuity. I agree to the above and have read the policies and procedures and agree to abide by the terms and conditions therein.

PHYSICAL ACTIVITY CONSENT
I have enrolled in a program of strenuous physical activity, offered by KCFAA. I hereby affirm that I or the above person is in good physical condition and does not suffer from any disability that would prevent or limit participation in this dance program. In consideration of myself, my heirs and assigns, hereby release the KCFAA, from any claims, demands, and causes of action arising from my or the above named person’s participation in any of the above stated programs, and I hereby release the KCFAA from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls, tears, broken bones, shin splints, heat prostration, knee, lower back, or foot injuries and any other illness, soreness or injury however caused occurring before, during or after participation in any other of the programs offered at KCFAA or at any time, while in the vicinity of the premises of the above stated business, or in any activity sponsored, represented, or organized by KCFAA, for any reason. By signing, I hereby affirm that I have read and fully understand and agree with the above waiver.

PHOTOGRAPHIC RELEASE
I agree that my picture or likeness can be represented and published in KCFAA publication/media or publication/media authorized by KCFAA.

By checking this box, you agree to the above KCFAA, Physical, and Photographic Consent & Release*

I Agree

Study with accomplished teaching artists

Stay Tuned for the next KCFAA Master Class Series

For intermediate and advanced level dancers

KCFAA Master Class Application