MDA Birthday Party Waiver

Mainstream Dance Academy

Birthday Party Waiver
*If your child is currently enrolled at Mainstream Dance Academy, you do not need to complete this form.
Child's Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian E-mail *
Parent/Guardian Phone Number*

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Release of Liability

As the legal parent or guardian, I release and hold harmless Mainstream Dance Academy, 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 while in or upon the premises or any premises under the control and supervision of Mainstream Dance Academy, its owners and operators or in route to or from any of said premises.

Video & Photo Waiver
I give Mainstream Dance Academy my permission for the public display of pictures and or video of my child for possible advertisement purposes (i.e. brochures, newspaper ads, web site, etc. - no names will be used).
I agree to all of the above, Parent/Guardian Signature*

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Mainstream Dance Academy