Altura Vista Pole & Dance Waiver & Liability Release
Name
*
First Name
Last Name
Email
*
example@example.com
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
-
Area Code
Phone Number
Disclaimer
LIABILITY & RELEASE WAIVER
MEDIA RELEASE (Optional): I grant permission for Altura Vista Pole & Dance Sayulita to use photos or videos taken of me during classes or events for promotional purposes, including but not limited to social media, websites, and marketing materials.
Yes
No
Signature
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