Cannon Arts Dance Studio Registration
Please bring with you or fill out at studio.
Student Name: ________________________________Age:_______
Parents Name:____________________________________
E-mail Address:____________________________________________
Cell Phone #:___________________home phone________________
Address:____________________________________________________
Please Circle Days attending: MON. TUES. WED. THURS. FRI . SAT.
Please list any health concerns or current medications:
AGREEMENT, WAIVER AND RELEASE
In consideration for being permitted by the above to participate in the above activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the above from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity.
PARENTAL CONSENT: (is to be completed and signed by parent/guardian if applicant is under 18 years of age.) I hereby consent that my son/daughter, ____________________________________, participate in the above activity and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity.
I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE ABOVE DISTRICT AND PERSONS AND
I SIGN IT OF MY FREE WILL.
Circle One:I do or I do not give permission for my child’s image to be used in printed publications, (newspapers) or on the internet(. internet news or cannon website/facebook)
_________________________ _______________________ Date
Parent Signature(if student under 18)
