Winter POP-UP Open Class Sign-Up and Liability Release Form

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Thank you for your interest in our dance event!

First Name *

Last Name *

Zip Code *

Email Address *

Which school do you attend? *

Are you bringing your friend? *

YES

Required

If you answered YES above, please enter your friend's first and last name. If you answered NO, enter n/a. *

(Optional) If you answered YES above, please enter your friend's email address so that we can send information and necessary forms for your friend to participate. If answered NO, enter n/a.

Would you like to receive email updates and announcements about upcoming Ririe-Woodbury/Dance Space for Kids events, including workshops like this? *

Yes

Liability Release Form: In consideration of the acceptance of my application for the Ririe-Woodbury Dance Company’s Winter POP-UP Dance Workshop, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in said event. I understand that participation in the dance activities involve certain inherent risks. Such risks are typically that of broken bones or contusions, but may also include severe injury or death. In order to obtain the desired benefit of participation in, use and enjoyment of the program’s activities, I fully release Ririe-Woodbury Dance Company, its respective employees, representatives and agents, from any and all liability for injury or damage to me resulting from my participation in the program, including, but not limited to, a complete and full release of liability for injuries resulting from the carelessness or negligence of the Ririe-Woodbury Dance Company, its respective employees, representatives and agents. I further agree to fully and completely indemnify the Ririe-Woodbury Dance Company, its respective employees, representatives, and agents, from any and all damages, whatsoever, which may result from my participation in the Winter POP-UP Dance Workshop.

Yes

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2024 MEDIA CONSENT. Event Description:Winter POP-UP Dance Workshop 12/9/24 . The undersigned hereby grants permission to Ririe-Woodbury Dance Company and its successors and assigns, to publish or cause the publication of my family's:♦ Photograph ♦ Videotaped Image ♦ Quotes/Comments for promotional and educational purposes in any and all media without limitation, reservation or compensation.

Yes

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