Take a Class Register Summer & Fall Classes Schedule Summer Camps Parties and Events Instructors Media Training Well, Training Safely Injuries Registration Form Registration MDG Registration Form Season * Student’s Name * Gender * MaleFemaleNon - Binary Preferred Pronoun * Registration date Age * (optional for Adult students) Participant's Date of Birth * Parents Names * (only if under 18 yrs of age) Home Phone * Cell Phone * Preferred number * Home Cell Mailing Address * Mailing Address Mailing Address Mailing Address City City Province Province Postal Code Postal Code Medical Concern (if applicable) Email * Initials * Privacy Policy Monica’s Danz Gym Inc. (MDG) has a privacy policy regarding the collections, use, retention, disclosure and disposal of personal information including email address. This policy is available at MDG. I consent to give MDG permission to gather personal information for the following purposes: registration, communication about MDG’s programs, events, and activities, registration to dance conventions, festivals or competitions, in case of a medical emergency, when necessary for insurance coverage, managing insurance claims and conducting insurance. Signature of Participant/Guardian * signature keyboard Clear Date Photograph Privacy Policy From time to time MDG takes photo and/or video footage of students either professionally in performance, or simply for educational or advertising purposes. I consent to having the participant’s photo provided to media (if applicable), for educational purpose, or ongoing MDG advertisement (i.e. web site). Signature * signature keyboard Clear Date Name of Participant * Please check applicable level of AERIAL APPARATUS TRAINING * Beginner (0-1 yr) Recreational Experienced (2-3 yrs.) Intermediate (4+ yrs.) Advanced Experienced (with Momentum Performance Team or 5+ yrs) DROP IN CLASS / Date of class * Payment * REGULAR CLASSES If you are registering for the season, please list the classes you are signing up for. * Payment * Aerial Danz Release Form In consideration of participating in this aerial danz (including silks, hoop & trapeze, harness, rope, and slings) class, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights & claims for any damages I may have against Monica’s Danz Gym Inc. and/or any instructors, assistants, of organizers of this class, its agents, representatives, successors, and assigns, for any and all injuries or damages which may be sustained and suffered by myself, through my association with or entry in this class. The Signer (or student) agrees to follow the instructor’s orders and not try any skills without clear instruction from the instructor. The Signer agrees to not endanger fellow students or the instructor by unauthorized use of the fabric or lack of due attention. The Signer agrees to not attempt to instruct anyone outside of class without completing advanced level training, in addition to prior approval from the school director Monica Goermann. Prior permission to photograph and/or videotape classes and/or rehearsals from the head instructor is required. NAME of PARTICIPANT * SIGNATURE of PARTICIPANT / PARENT or LEGAL GUARDIAN (if participant under 18 years old) * signature keyboard Clear Signed in Winnipeg, Manitoba on Captcha Submit If you are human, leave this field blank. Δ Home Classes Register Fall Classes Summer Camps Schedule Parties and Events Momentum About Us Photos/Videos Performances Booking & Contact World Gymnaestrada About Studio Instructors In the Media FAQ Events/News MDG student Momentum Aerial & Acrobatic Troupe Contact