Dance Mania Nashville Free Trial Classes
Sign in to Google to save your progress. Learn more
Dancer Name *
Dancer DOB *
MM
/
DD
/
YYYY
Parent Name *
Email *
Contact Number
*
Choose your Free Trial Class! *
Emergency Contact Name & Number
*
I understand that dance and acrobatic instruction requires physical exertion. I also acknowledge that injury may result during instruction, including but not limited to as a result of physical contact with other students, instructors, or fixed or movable objects, or the condition of the floor: I represent that I am medically and physically able to safely participate in dance classes, workshops, rehearsals, photo shoots and performances (collectively, hereinafter, the "Program(s)") and to meet the physical demands thereof. 

I agree to assume all risks associated with participating in dance instruction or workshops at or in connection with Dance Mania Nashville, its officers, directors, employees, agents, successors, predecessors, sponsors, legal representatives and assigns (collectively, hereinafter, the Producers).  

If, at any time hereafter, I have any medical or physical limitation or condition that might affect my ability to safely participate in the Programs) or meet the physical demands required thereof, or have any concerns with regards to the Program(s), I will make immediately notify the Producers or opt to sit out of said Program.

In view of the foregoing, and as a term and condition of participating in the Programs) with the Producers, I, for myself, my spouse, heirs, legal representatives and assigns, expressly release, waive and discharge, from all present and future claims, demands, actions, judgments, executions and liabilities of any kind, known or unknown, that now have, ever had or may have, or claim to have, against the Producers, created by, or arising out of, my involvement in the Programs), regardless of where or when held, even though such claim or liability may arise out of negligence or fault on the part of any of the Producers, breach of contract or otherwise, and whether for bodily injury, property damages, loss or otherwise. 

This release is also for the entire premises of the Producers, including but not limited to dance rooms, tumbling rooms, office and lobby space, costume room, bathrooms, hallways, parking areas, sidewalks, alleys, stairwells, buildings and grounds.

By participating in the Programs), I hereby grant the Producers the right and permission to use my likeness in photograph, video, and sound for the production and website currently titled "Dance Mania Nashville,” as well as "related promotions" including but not limited to social media for the Producers.

This acknowledgement of risk and waiver of liability, and release of likeness, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.
*
Required
Participant Signature -
If the participant is under 18, this waiver must be signed by a parent or legal guardian on behalf of the minor. (Please type full name as a form of signature)
*
Date of Signing
*
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kirstin Hawk Blevens.

Does this form look suspicious? Report