MarShere New Client Enquiry Form with COVID-19 Terms of Service

Enquiry Form
Date*
MonthDayYear
Date
Name*
First NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Birthday*
MonthDayYear
Date

MarShere Dance Studios - Frankston COVID-19 and Social Distancing Terms of Service Agreement
I acknowledge the additional safety measures being implemented by MarShere Dance Studios during the COVID-19 Response and will cooperate with their enforcement and application, including:
• Following the direction of MarShere Staff
• Completing a Temperature Check on arrival for each session
• Adhering to Social Distancing guidelines
• Adhering to limits to class numbers
• Maintaining good hygiene, whilst in the studio
• No partnered dancing in classes, only in private lessons where the partner meets requirements for eligible exemption from social distancing rules (i.e. someone you are already in contact with such as a romantic partner or a person of your household and are except from distancing under the govenment guidelines)
• I will not attend if I am feeling unwell or exhibit flu like symptoms including:
- fever
- dry cough
- tiredness
- aches and pains
- sore throat
- loss of taste or smell
I have read and agree to the above terms of service*
Yes
Do you have a partner to dance with that is exempt from social distancing requirements?*
YesNo

Partnership Declaration
I wish to undertake private dance lessons where I may take up “dance hold” (full contact) with my partner. I declare that:
1. My dance partner is someone who I am normally in contact with as a life or romantic partner,
or someone who I am cohabitating with; and
2. Participation in these lessons does not present an additional physical exposure.
I acknowledge that the teacher will maintain social distance and no contact throughout all lessons
Name
First NameLast Name
Relationship

Declaration and Consent
I hereby warrant that I do not hold MarShere Dance Studios or any of its employees responsible for anyn accident, injury or damage that may occur whilst on these premises. I understand that my property is my responsibility and do not hold MarShere Dance Studios responsible for any losss incurred. I authorise MarShere Dance Studios to seek necessary emergency medical, hospital, dental or ambulance services in the event of an accident occuring (this will be at my expense). I authorise the use of photography and videoing within MarShere Dance Studios for promotional purposes. I have read the MarShere Dance Studios Customer Code of Conduct and agree to the terms and conditions.
Signature*
Clear
Name, or name of parent/guardian if this form relates to a person under the age of 18 years old*
First NameLast Name
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