HSSD WAIVER FORM

Dancer's FULL Name*

Parent/ Guardian FULL Name*

Parent/ Guardian Email*

example@example.com

Parent/ Guardian Cell Phone*

Format: (000) 000-0000.

Hm. Phone

Format: (000) 000-0000.

Mailing address*

(123 Street Name, City, State, Zip Code)

Student's Date of Birth (MM/DD/YYYY)*

CURRENT AGE*

Please Specify Location of Choice- STONE OAK or BOERNE*

I/We realize the possible risk of injury in all classes offered at Heather Stolle's School of Dance. Therefore, I am releasing and waiving Heather Stolle's School of Dance, the owner, staff and instructors from any liabilities, claims, expenses that may arise from participation in any classes offered.

Dancer's FULL NAME*

Parent/ Guardian Signature*

Date*

Date

What type of class is your dancer interested in?