STILL DANCING REGISTRATION AND RELEASE FORM 2026

STILL DANCING REGISTRATION & RELEASE FORM 2026
I expressly assume the risk of participating in STILL DANCING with Dancenorth. I release and agree to indemnify and hold harmless Dancenorth and it's officers, agents and staff from any and all claims resulting from or arising out of my participation in the program including without limitation all claims, demands, causes of action, suits, losses, or damages due to my injury or death during my participation in STILL DANCING.

I hereby give my consent for Dancenorth to record, copy, edit, adapt, modify, distribute or exhibit my image, likeness, voice, and/or transcript, in whole or in part, in any form of media, and including the right to sublicense these rights for educational and promotional/publicity purposes for an undefined period of time. I understand that I will not recieve any payment or consideration in signing this release.
Participant's Full Name:*

First NameLast Name
Date of Birth:

MonthDayYear
Date
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.
Email:*
Please list any accessibility requirements, or anything that will help our facilitators to know to help support your experience.
For example mobility aids, Auslan interpretation, frequent breaks, access to a quiet space, etc.
Have you attended class with Dancenorth before:*

YesNo, I am a new student
Emergency Contact Full Name:*

First NameLast Name
Relationship to participant:
Emergency Contact Phone Number:*
Please enter a valid phone number.
Signature

Clear
Should be Empty:

STILL DANCING REGISTRATION & RELEASE FORM 2026