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Participant Age *
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Adult Name *
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My private teacher is... *
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I understand that all children under age 16 must be accompanied by an adult. *
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I allow any photos or videos of my child taken at the event to be used, nameless, by the organizers in publications or news media. *
I understand that I, as a parent of a child participating in the Fiddle Workshop & Family Barn Dance February 23 & 24, 2018 at (location), am fully responsible for my child's safety and well being. I will not hold Lorraine Westermark, Jessica Landes, clinicians, or (location) liable for any injuries or damages during this two-day event. *
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