DanceBlue Dancer Registration Form 2012

* Required

General Information

Contact Information

General DanceBlue Information

Medical Information

All provided medical information will be compiled by the DanceBlue medical staff and used in case of an emergency.

Emergency Contact Information

Indicate two family members to contact in case of emergency.

DanceBlue Dancer Aggreement

In consideration of the University of Kentucky granting me permission to participate in DanceBlue 2012, I declare myself physical sound and suffering from no condition, impairment, disease or infirmity, or other illness that would prevent my participation. I acknowledge that I have either had a physical examination and have been given a physicians’ permission to participate, or that I have decided to participate in this activity without the approval of my physician and do hereby assume all responsibility for my participation in this activity including risks of property loss and personal injury, including death. I do hereby release the Commonwealth of Kentucky, and their employees and agents from any and all liability as a result of my participation, unless such liability is a direct result of the University of Kentucky's negligent acts or omissions. I understand and appreciate the inherent risk of participating in DanceBlue. I know that these risks include but are not limited to, exhaustion, physical injury, and loss or damage of personal property. I fully assume the inherent risks associated with DanceBlue and assert that I am voluntarily participating. The University of Kentucky reserves the right to require that I withdraw at any time when in the sole judgment of University officials, it is not physically safe to continue participating. I agree to assume any and all costs of any required medical treatment. I understand that by checking below, I have read this release of liability, fully understand it, freely and voluntarily sign it, and I am acting for myself, my heirs, personal representatives and assigns in doing so.

Dancer Responsibilities Agreement

I agree to pay the $35 dancer registration fee via Plus Account, check, or cash at the UK Student Center ticket office by Monday, February 13th at 12 PM. I acknowledge that this fee is non-refundable. Additionally, I agree to attend the mandatory dancer information meeting on Wednesday, February 29th. If I am unable to attend I will notify Tressa Neal at and attend the make-up meeting on Sunday, February 26th.

Media Agreement

I hereby grant permission to the University of Kentucky and its affiliates and subsidiaries, including but not limited to the UK Alumni Association, and UK Research Foundation, to interview, photograph, and/or videotape me; and/or to supervise any others who may do the interview, photography, and/or videotaping; and/or to use and/or permit others to use information from the aforementioned interview and/or the aforementioned images in educational and promotional activites for UK Educational Publications/Videos, UK Electronics Publishing (e.g. World Wide Web), UK Promotion/Advertising, and Local/Regional/National News Media (w/ permission of UK) without compensation.

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