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USA Dance, Royal Palm Chapter # 6016 - Sponsor/ Organizer of the Royal Palm Dancesport Competition

2018 Royal Palm Dancesport Competition

Teacher/ Student Information & Release Form

Required From All Teachers & Students

(You can submit this Form once for a Teacher & all his/her Students)

 

Teachers & Students:

Please complete the information for the Teacher and up to 2 Students in the first part of the form below. Include the same information for any additional Students in the text area "For Teachers Entering with More than 2 Students" below. Be sure to complete all blanks and checkboxes marked "(required)," or the form will not submit.

Please type the full names of the Teacher and each Student (separated by commas) in the Signature blank at the bottom to sign and accept the Terms & Release Form (required), and click the red "Send" button at the bottom to submit this Form from the Teacher and all named Students.

Teachers, Note:   If any of your Students are under 19 years old, you must have the parent or guardian for each such Student under 19 also submit a Parental/ Guardian Consent & Release Form (linked above).

Upon submitting this Form, you will each receive an e-mail with registration instructions and a link to our O2cm Online Registration Form where the Teacher (or one of you) can sign in and register all of you at one time for the 2018 Royal Palm Dancesport Competition. If you have already registered or are not the one handling the registration for all of you, you can disregard the e-mail.

Teacher:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):


Gender of Teacher: (required)
 Female Male

If you are a Member of USA Dance (or Affiliated Organization), please fill in your Membership Number & Expiration Date (membership not required for Pros)

If you are a member of USA Dance, which Chapter? (if applicable):

Student # 1:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):


Student's USA Dance (or Affiliated Organization) Membership Number & Expiration Date (required)

USA Dance Chapter of which Student is a member (if applicable):

Gender of Student: (required)
 Female Male

Age of Student: (required)
 18 or Younger 19 or Older

Student # 2 (if applicable):

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):


Student's USA Dance (or Affiliated Organization) Membership Number & Expiration Date (required)

USA Dance Chapter of which Student is a member (if applicable):

Gender of Student: (required)
 Female Male

Age of Student: (required)
 18 or Younger 19 or Older

---

Any Additional Students:
Required For Teachers Entering with More than 2 Students:

Enter below the Names and full Contact Information (and all information called for above) for each other Student you will dance with in the Royal Palm Dancesport Competition. INDICATE FOR EACH STUDENT WHETHER HE/SHE IS YOUNGER THAN 19:

Terms & Release Form (required of all Competitors):
Please read and Accept the following Terms & Release Form (required of all Competitors), and then Type all of your names (separated by commas) in the Signature Blank below, and Click "SEND" below to submit your Teacher/ Student Information & Release Form from the Teacher and all of his/her Students.

Terms & Release Accepted and Agreed (required of all Competitors):
- By submitting this Teacher/ Student Information & Release Form and/or by registering for the Royal Palm Dancesport Competition, each Teacher and each Student Competitor identified above hereby represents and agrees as follows:

1. Payment of Competitor Entry Fees Due. I agree that upon completing the Entries portion of the online Competitor Registration form on O2cm, I/ we will complete Steps 5 and 6 of the O2cm form to add the applicable Competitor Package due for each Competitor, and immediately use the "Pay Now" button found at the bottom of the O2cm Registration Form to pay in full the Competitor Package fees and Entry Fees applicable for our entries via PayPal or Credit Card. I/ we understand that our Registration is not complete until the Competition Organizer receives full payment of our Competitor Package fees & Entry Fees, as well as our Registration Form.

2. Waiver & Release Accepted and Agreed: I have read, understand and agree to abide by the USA Dance DanceSport Rulebook, as and to the extent applied at the Royal Palm Dancesport Competition, and the Rules, Regulations and Guidelines for this Competition, as set forth on www.RoyalPalmDancesport.org. I state, warrant and represent that I am eligible to enter all events for which my partner and I register and that we will not register for an event below the Student's minimum proficiency level in each category or above the Student's maximum Age Category. I understand all athletes may be subject to drug testing by the WDSF or USA Dance. I agree to be bound by the USA Dance DanceSport rules as and to the extent applied at this event; and, if I am an Amateur Athlete Member of USA Dance, I understand that if I violate these rules, my Amateur Athlete competitor status with USA Dance may be suspended. I understand the Competition may be filmed/videoed/photographed and I agree that the organizers may use my images, videos, and my name for promotional or other purposes related to the Royal Palm Dancesport Competition, now or in the future. I consent to receiving e-mails or communications from the organizers, now or in the future (from which I may unsubscribe after the Competition, if I so choose). I understand and agree that no responsibility for bodily injury or for loss or theft of articles left in the changing rooms, Competition venue, practice room, seating areas or elsewhere by persons attending or participating in this event, can or will be accepted by the organizers, USA Dance, Inc., the Royal Palm Chapter of USA Dance, Goldcoast Ballroom, any of their respective officers, directors, agents or representatives, or any hotel, and I hereby release, hold harmless, and agree to indemnify all of the foregoing persons & entities from any and all claims or liabilities of any kind arising in connection with my/ our participation in or attendance at the Competition. I understand and agree that everyone attending the Competition does so at his or her own risk.

Please be sure you have filled in all blanks above that are marked "(required)."
All blanks marked "required" must be completed in order to submit this form.

To Submit Your Teacher/ Student Information & Release Form:

Step 1:   Type the full names of the Teacher and all Students submitting this Form (separated by commas) in the Signature Blank below, and Click the Red "SEND" button to Submit this Teacher/ Student Information & Release Form. You should then see a message outlined in green on your screen below, saying, "Your Teacher/ Student Information & Release Form was submitted successfully."

Step 2:   Watch your E-mail. You will receive an e-mail with instructions and a link to the O2cm Registration Form, where you can Register for the Competition and pay your Competitor Registration and Entry Fees. Your Registration will not be complete until we receive both your Registration Form and your payment. (If you have already registered for the Competition (or, if you are the Student and your Teacher will do so for you), you can ignore the e-mail you will receive. As soon as you have paid in full, you are done.)

Signatures: (required - this form will not submit without typed in signatures)

Thank you for your interest in our 2018 Royal Palm Dancesport Competition!

We look forward to seeing you at the Competition on Saturday, January 20, 2018!!

If you do not receive the e-mail with link to our O2cm Registration Form within a few minutes, please check your Spam folder, and if not there, or if you have any questions, please e-mail us at: RPC@royalpalmdancesport.org.

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The Annual USA Dance Royal Palm DanceSport Competition - now in it's 15th year -
is one of the most highly regarded dancesport competitions in Florida and in the United States.
We welcome amateur competitor couples from around the United States, Canada, and the world!
Starting in 2018, we will also include Teacher/ Student and Pro/Am Events!

Competition Sponsors & Principal Donors: