Waiver

MDW WAIVER

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PARTICIPANT'S NAME *

First

Last

PARENT/GUARDIAN NAME (IF APPLICABLE) *

First

Last

ADDRESS *

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Line 2

City

State

Zip Code

Country

PHONE NUMBER *

EMAIL ADRESS *

RELEASE

I hereby acknowledge the health of my child to be ready for vigorous activity during dance or acrobatic lessons and/or events and authorize the directors to secure any emergency treatment deemed necessary. I hereby release the teachers, assistants, personnel, and Montana Dance Works from all claims for injuries sustained while participating in this program. I hereby acknowledge that Montana Dance Works may take and use photos/videos of my child(ren) for marketing material.

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YES, I ACCEPT NO, I DO NOT ACCEPT

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