Twinkle Toes Hi Desert Class Waiver
Please read and sign the waiver form to participate in the dance class, free trial or private lesson
Participant's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Release of Liability and Assumption of Risk, the undersigned participant, understand that participation in dance classes and related activities involves physical activity and carries inherent risks of injury, including but not limited to muscle strains, sprains, falls, and other physical injuries.I voluntarily choose to participate in these activities and assume all risks associated with my participation. I certify that I/my child is physically able to participate and will notify the instructor of any medical conditions or limitations that may affect my ability to safely engage in class activities. In consideration for being permitted to participate, I hereby release, waive, and discharge the instructor/Twinkle Toes Hi Desert, The city of Yucca Valley, Joshua Tree Yog and Theatre 29, and their respective employees, volunteers, agents, and representatives from any claims, liabilities, demands, or causes of action arising out of or related to any injury, loss, or damage that may occur during or as a result of my participation, except where caused by gross negligence or willful misconduct to the extent prohibited by applicable law. I understand that I am responsible for my own health, safety, and personal belongings during the class. I have read this waiver, fully understand its contents, and sign it voluntarily.
Please read the above
Signature
Requested Class/Classes Day/Time
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