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The information in this form will be used in the signing of your document.

Once you have verified the information below please review your information before submitting. 


Which class would your child like to register for?



Emergency Contact Information

Injuries/Medical Conditions

Does you child need any additional support in classes? eg; SEN needs

Please note you are about to read & sign documents that could affect your legal rights. 

Please read all the information carefully and ensure all information submitted is accurate.

  • I am aware that participating in exercise classes, either online or in person and as such exercises classes may involve inherent risks and hazards. I freely accept and fully assume all such risks, dangers, hazards and the possibility of personal injury, property damage or loss resulting in such risks/hazards. 

  • I voluntarily agree to release Vixen Dance & Fitness and Bella Statton from any and all liability for any loss, damage, injury or expense that I, my child, next of kin, successors or dependants may suffer or incur as a result of participation in either online or in person classes due to any cause including negligence on the part of Vixen Dance & Fitness or Bella Statton.

  • I understand that Vixen Dance & Fitness and Bella Statton will not assume responsibility for any lost or stolen property or for any bodily or personal injury consisting of or arising out of any participation in physical training. 

  • By signing this agreement you are confirming you have read and agreed to all of the policies and terms & conditions.

Photography/Videography Consent

  • Vixen Dance & Fitness and Bella Statton may record/photograph parts of classes/exercises for promotional purposes.      These may be used on the website, and or social media sites. 

  • Participants may take photos/videos of themselves for their own personal use but are not permitted to take photos/videos of others unless consent is given either verbally or in writing.

  • Parents may take photos/videos of their own child during classes but may not take photos or videos of other children. 

  • No personal information will be released unless consent is given either verbally or in writing.

  • All photos, videos and and personal information will stored securely.

  • Please give your consent to Vixen Dance & Fitness/Bella Statton to take photographs and video recordings of you or your child during classes. You may opt in/out of this consent at any time by emailing Bella at

  • I understand that by stating No my child will not be included in any photographs or videos during class or performances. 

Please confirm your consent to Photography/Videography of you or your child

Physical Contact Consent

  • I understand that in classes, in the interest of safety, it is essential for Bella Statton/Vixen Dance & Fitness to help students using physical contact (touch).

  • I understand that by stating No that Bella will not be able to help my child with certain exercises during class and my child will not be allowed to participate in those exercises

Please confirm your consent to physical contact towards your child.
  • By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. I will not at any future time, claim that my electronic signature is not legally binding or enforceable.

  • By electronically signing and submitting this agreement I, acknowledge that I have read and fully understand all the policies and terms & conditions.

  • I voluntarily agree to be bound by this agreement. 

  • I can confirm I am at least 18 years old or older. 

  • I can confirm that I am the parent/legal guardian signing this document on behalf of any minor under the age of 18. By electronically signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf of the minor(s) listed above.

  • My signature applies to all sections and pages of this contract. I understand that I will receive a copy of this agreement after it is signed to the email I have provided. To view this document I understand that I need software such as adobe reader or other compatible software capable of reading this document.

  • To obtain a printed copy of this agreement I understand I will need access to a printer connected to my computer. 

  • I understand that if I would prefer to sign a hard copy I need to contact Bella Statton at

By submitting this agreement you are confirming that all of the above information is correct.

If you have any questions please contact Bella Statton.

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