PBD Parental Consent Form
All friends attending PBD's Friend Week must have a Parental Consent Form filled out to participate. One per participant.
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Participant's First & Last Name *
Participant's Age Catagory *
Required
Participant's Grade (or Age) *
Guardian's First & Last Name *
Email *
Phone Number *
By checking this box I give my child permission to participate in Pacific Ballroom Dance activity and give permission to PBD to seek medical treatment for my child if needed.  I understand that Pacific Ballroom Dance will not be held responsible for injury or harm to my child during this event.  *
Required
By checking this box I hereby grant Pacific Ballroom Dance permission to use the likeness of my dancer in photographs or video recordings in any publications or publicity materials (including but not limited to posters, newsletters, videos and web use), in perpetuity. I will make no monetary or other claim against Pacific Ballroom Dance for the use of these photographs or videos. *
Required
How did you hear about us? ( or who is my PBD friend?) *
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