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Dancer's Birthday
Are you a current dancer?
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Assumption of Risk


Participant and Guardian (if Participant is a Minor) agree TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with, or related to Participant’s participation in the Program, transporting to or from the Program, or as a result of any natural disaster, extreme weather condition or event, or any other occurrence during Participant’s participation in the Program, natural or otherwise, even though such risks may have been caused by the negligence of the program. This assumption and acceptance of all risks includes, without limitation, any medical expenses that Participant or Guardian may incur as a result of Participant’s personal injury or illness.

Release of Liability


As the legal parent or guardian or participant, I release and hold harmless Daliana Dance, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Daliana Dance, its owner and operators or in route to or from any of said premises.  You also understand that you are financially responsible for any and all related medical expenses that are a result from injury as a participant.

Medical Emergencies


Medical Emergency (Only if under 18)

The undersigned gives permission to Daliana Dance, its owner and operators to seek medical treatment for the participant in the event they are not able to reach a parent, guardian or emergency contact you provide. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health.

Audio/Video/Photo Waiver/Release Form


I hereby grant irreversibly Daliana Dance the right to use and reproduce any and all photographs, video clips, and/or audio clips taken of me or my child in any form whatsoever for use by Daliana Dance in newsletters, brochures, web sites, flyers, and in any other publications produced for the aforesaid school. My child or I can have their picture taken, but at times may not have his/her name printed along with the photo. I waive the right to inspect or approve the finished version(s) of such images including written copy that may be created in connection therewith. Consent is also granted for any use of my (or my child’s) name in any part of those publications listed above. I have read this document and am fully aware of the consent and implications, legal, and otherwise.

What clinic are you registering for?
Pom Clinic
Nutrition Clinic
Flexibility Clinic
Improv
Body Awareness and Recovery
Clinic Fee
Not a Member Yet$50
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