Dance Audition Masterclass
Please use this form to save your spot in Mill Mountain Theatre's Dance Masterclass on November 4th from 10am-12pm
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Email Address *
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Phone (Parent/Guardian) *
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Email (Parent/Guardian) *
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Emergency Contact Name AND Relationship to Student *
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Allergies/Other Healthcare Needs *
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Insurer *
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Insurance Policy # *
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School *
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Grade *
***PLEASE READ CAREFULLY BEFORE SIGNING***
RELEASE AND WAIVER: The undersigned understands that participation in Mill Mountain Theatre or other educational programs at Mill Mountain Theatre will expose students to activities and equipment which can cause accidents and injuries, and that Students will not be supervised outside of class time. The undersigned acknowledges receipt of the "Conditions of Participation" and agrees to abide by the requirements contained therein. In consideration of Student's acceptance into MMT Educational Programs, that the undersigned does hereby release, waive, discharge, indemnify, and hold harmless Mill Mountain Theatre, its directors, officers, employees, and agents, from and against any claim for damage, injury, loss, or death to the above named student resulting from participation in any class, program, play, or other activity either at Mill Mountain Theatre or at another location, including any damage, loss, or injury resulting from failure to abide by the "Conditions of Participation." With a child's registration in classes, parent/guardian grants permission to take pictures and recordings of class/performances for publicity and promotional purposes (website, publications, etc.).

HEALTHCARE AUTHORIZATION: The undersigned hereby authorizes Mill Mountain Theatre employees to do any acts which may be necessary or proper to provide emergency healthcare of any student in the event that the Parent/Guardian cannot be reached, including consent to and authorization of medical procedures by physicians, dentists, hospital or other emergency medical personnel, as they, in the exercise of their sole discretion, may deem necessary. The undersigned understands that (s)he is responsible for all costs and expenses of such medical treatment.

I have read the above waiver and release liability and by signing, I agree that it is my express intent to exempt and relieve Mill Mountain Theatre and its employees from liability for personal injury or wrongful death other than claims that rise as direct result of active or foreseeable negligence. I certify that I have full authority to sign this release and authorization. *
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