Policy | hope-burt

Liability Waiver

First Name

Last Name

Date of Birth of Student required

Phone Number

Please specify any allergies we should know about

Dancers Name

Gender

Address

I hereby acknowledge this release from liability for accidental injury or illness which I or my child may incur as a result of participating in this program. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

I understand that in this Program or related activities, I or my child may be photographed or filmed. I agree to allow my child's photo, video or film likeness to be used for any legitimate purpose by the Program.

Please be on time to pick up your child after class. If a parent is late past 5 minutes, you will be charged $1.00 per minute to pay for the teacher to stay and supervise your child. This charge will be debited to your card on file immediately. If your card is declined, your child will not be allowed to return to class until it is paid.

All Dance class students are expected to be on their best behavior during dance class. If Dance class student consistently disrupts the learning environment, they will lose their place in the class.

I declare that the info I’ve provided is accurate & complete

Your Signature

Thanks for submitting!