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BellaMoxi Corps Application

BellaMoxi Corps Application

  • Personal Information

  • Legal Guardian Name
  • Dance Studio/School Information

    This should be the home studio where you receive the majority of training during the week. College/University and Pre-Professional program students please provide the information for an accessible advisor or professor.
  • Primary Contact Information

    By checking each box you are agreeing to all terms and rules provided.
  • Briefly answer the following questions.

  • Please insert one link per line. Two (2) videos are required for submission, but if you have additional videos, please place them in fields below.
  • Please insert only one link.
  • Please insert only one link.
  • If you can not link, please send in an email after application is submitting to info@bellamoxi.com
  • If you can not link, please send in an email after application is submitting to info@bellamoxi.com
  • If you can not link, please send in an email after application is submitting to info@bellamoxi.com
  • LIABILITY RELEASE FORM

    As custodial parent or guardian I hereby authorize the chaperone listed below and the Directors and employees of BellaMoxi LLC to take my child to any hospital emergency room (for treatment), without first obtaining my consent in the event my child is sick, hurt, or in need of medical attention, and it is impracticable or impossible for the below named chaperone or a representative of BellaMoxi LLC to get in touch with me prior to obtaining medical attention for my child. I do further release and absolve BellaMoxi LLC, its directors, employees, and contractors from any liability as a result of obtaining such medical treatment for my child. Further, I authorize the doctor or doctors, nurses, hospital, or emergency room of any hospital to render the treatment necessary for the illness, sickness, or injury of my child who is brought to such institution for treatment by the above named chaperones, or by any director, employee or other representative of BellaMoxi LLC. I have provided my student’s chaperone with the appropriate insurance information in the unlikely event of an injury that would require emergency treatment. I fully understand by typing my name below and submitting this form that the participant registered above will be engaged in intense physical activity that contains the inherent risk of physical injury. Knowing that fact, I release and agree to hold harmless BellaMoxi LLC, its directors, employees, contractors, and event hosts from any liability for personal injury or property damage while the participant is enrolled. Enrollment and participation are the sole risk of participants and legal guardian. Typing your name below is agreeing to above all mentioned items and will serve as your electronic signature for this form.
  • Typing your name is agreeing to above all mentioned items and will serve as your electronic signature for this form.
  • Price: $75.00
  • $0.00
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