CSDA, Inc Waiver Form

“I, the parent and/or legal guardian of the below-named dancer(s), hereby give permission for said dancer(s) to participate in all classes, programs, and events offered or conducted by CSDA, Inc. d/b/a Center Stage Dance Academy. For myself and said dancer(s), I acknowledge and accept all risks associated with such programs, classes and events, including the possibility of serious physical harm or injury. For fair consideration, I hereby release and indemnify CSDA, Inc., Its employees, or unknown, now existing or hereafter arising, sustained or suffered in connection with said dancer(s)`s participation in any such class, program or event. Further, I grant permission to CSDA, Inc. to use photographs and/or videos of said dancer(s) as deemed appropriate or fit by CSDA, Inc. in the operation of its business.”


Child's/Participants Name:
Parents Name:
Mailing Address:
City:
Zip:
Email Address:
Home Phone:
Cell Phone:
Age:
Birth Date:
Allergies or Medications:

EMERGENCY CONTACT INFORMATION

Emergency Name:
Relationship:
Address:
City:
Zip:
Home Phone:
Cell Phone:
Date:
I have Read and Understand the CSDA, Inc Liability Waiver Yes


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