Annie Jr Workshop Waiver & Media Release
Complete this form to release Dance Workshop in Minden, NV and Sierra Spotlight Youth Theater from liability and grant media consent for Annie Jr (June 29–July 17, 10 AM–2 PM, special performance July 17 at 2 PM).
Participant Full Name
*
First Name
Last Name
Participant Date of Birth
*
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Month
-
Day
Year
Date
Parent/Guardian Full Name (if participant is under 18)
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Needs and Requirements
Liability Waiver
*
Media Release
*
Signature of Participant or Parent/Guardian
*
Date Signed
*
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Month
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Day
Year
Date
Submit Waiver
Submit Waiver
Should be Empty: