STUDIO 34 DANCE ACADEMY
LIABILITY WAIVER


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.




Signature of Student over 18 years oldPlease PRINT name of Student


Today's Date Month/Day/Year

or


Please write the name(s) of student receiving lessons


Signature of Parent or GuardianPlease PRINT name of Parent or Guardian


Today's Date Month/Day/Year


Does the student(s) have any allergies or other special medical needs we should be aware of?
If so, please list below:








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.



Your nearest friend or relativeTheir phone number