Class Waiver Form

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Class Waiver Form

Please fill out this waiver before class! Thank you!

Email *

First Name (parent/guardian/adult) *

Last Name (parent/guardian/adult) *

First Name (child)

Last Name (child)

Cell Phone Number *

Emergency Contact Name and Phone Number *

Which Wednesday will your dancer be attending? *

July 29th

August 5th

August 12th

August 19th

August 26th

Which Wednesday class will your dancer be attending? *

4pm for dancers ages 3-5

5pm for dancers ages 5-7

6pm for dancers ages 8-10

I will not hold Shoreline Dance Academy liable for any injury that may occur to either myself or my child while at Shoreline Dance Academy. I understand that there is physical risk involved when participating in dance classes. *

I understand

Required

I hereby consent to the photographing of the aforementioned person and the recording of the aforementioned person's voice and the use of these photographs and/or singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I hereby release Shoreline Dance Academy and any of its associated or affiliated companies from all claims of every kind on an account of such use.
*

I consent for photo/video to be taken

I do not consent for photo/video to be taken

A copy of your responses will be emailed to the address you provided.

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