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| | Studio 34 Dance Academy Liability Waiver | |
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| | My signature below releases Studio 34 Dance Academy, Inc., its officers, directors, staff, employees, and independent
contractors, volunteer helpers, and landlords from any and all liability that may result from myself, my children, or any member of my family participating in dance lessons, exercise classes, rehearsals, parties, private lessons, performances, field trips, or any function sponsored by Studio 34 Dance Academy, Inc.. | |
| | I agree to hold Studio 34 Dance Academy, Inc., its officers, directors, staff, employees and independent contractors, volunteer helpers, and landlords 100% harmless for any and all injury that may result from my dancer, myself, or any member of my family participating in the activities listed above. Our participation is completely voluntary. | |
| | I have listed any special medical problems that I have or my child receiving dance lessons has below. Our family doctor approves of our participation in the above listed activities in spite of
these medical problems. My signature verifies that I have read this waiver and agree and accept its contents. | |
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Signature of Student over 18 years old | _______________________________________
Please PRINT name of Student |
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Today's Date Month/Day/Year | | |
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Please write the name(s) of student receiving lessons | |
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Signature of Parent or Guardian | ________________________________________
Please PRINT name of Parent or Guardian | |
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Today's Date Month/Day/Year | |
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Does the student(s) have any allergies or other special medical needs we should be aware of?
If so, please list below:
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Please give us a name and phone number of your nearest relative or friend that we may call in an emergency, if we cannot reach you.
(i.e. stranded child, stomach ache, etc.) In a crucial emergency 911 will be called. | |
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Your nearest friend or relative | ________________________________________
Their phone number | |
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