Artist Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Number *

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AGREEMENT: I, the undersigned, hereby forever release, discharge, & acquit MSA EDUCATE and 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 MOVEMENT EVOLUTION. This expressly includes, but is not limited to, any injury or damage caused by or resulting from the negligence of MSA EDUCATE or 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 MSA EDUCATE 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 $695 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 sales are non-refundable. If I am not able to attend an event purchased, a credit towards a future event will be awarded if I give a two week written notice prior to event dates of the originally purchased intensive. If I cancel within two weeks of the purchased event dates, no credit or refund will be given. *

I agree.