MOVEMENT MASTERS PA.
"DAY OF DANCE"
STUDENT NAME
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
EMERGENCY CONTACT NAME
*
First Name
Last Name
EMERGENCY CONTACT #
*
Format: (000) 000-0000.
I, on behalf of myself, my heirs, executors, agents, assigns, and representatives, hereby indemnify, release and forever hold harmless MOVEMENT MASTERS, an enterprise, as well as its directors, employees and instructors, from any and all claims of liability arising from any accident, personal injury, property loss or damage sustained by my child/myself, while that person is participating in activities connected with MOVEMENT MASTERS including classes, rehearsals, performances, or other activities. I understand that dance activities have inherent risks of injury, and, being fully aware of all risk, I consent to have my child/myself , participate in the programs and activities offered by MOVEMENT MASTERS , and I accept full responsibility for providing adequate health and accident insurance coverage for the protection of all of the following who participate in these programs/activities: my child/myself. By signing this statement, I declare that the aforesaid participant is in good health, with no physical conditions that might prevent his/her/they/my participation in strenuous and vigorous dance activities and other training and performance connected with dance.I have carefully read this Agreement and fully understand its contents. I understand that this is an assumption of risk and release of liability, and I sign it of my own free will.I also authorize MOVEMENT MASTERS to use photos and videos of my child/myself for promotional purposes. If I am signing this in my capacity as the legal guardian of a minor child, I authorize MOVEMENT MASTERS to use photos and videos of the minor child for promotional purposes.
*
I AGREE WITH THE ABOVE TERMS AND CONDITIONS
Signature
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