REGISTRATION: TRIAL CLASS

Dancer’s Name *

Age *

Grade *

Parent Name(s) *

Email Address *

Does the dancer have medical issues or allergies? Is there any additional information that would be important for us to know?

GCDC WAIVER

Will you be staying on site during the trial class? *

YES (skip question 2)

NO (answer question 2)

If you answered NO to question 1, you must leave a phone number where you can be reached in case of emergency. *

If I cannot be contacted, I authorize Grace Christian Dance Company, LLC to seek medical services in case of serious injury or illness. I further agree to accept financial responsibility in excess of the benefits allowed by my health plan. *

I agree.

I am aware that participating in any dance classes and acrobatic dance/tumbling (acro-dance) involves inherent risks and hazards. I freely accept and fully assume all such risks, dangers, and hazards and the possibility of personal injury, property damage, or loss resulting from such risks and hazards. I voluntarily agree to release Grace Christian Dance Company, LLC, Grace Christian Dance Company, LLC’s employees/volunteers/contractors and Danielle Black from any and all liability for any loss, damage, injury or expense that I or my next of kin, successors or dependents may suffer or incur as a result of participation in classes, camps, demonstrations, performances and any and all athletic activity. *

I agree.

By signing below I acknowledge that I have read the foregoing waivers and understand all content; that I am the parent or guardian of children listed above and I am fully competent to give my consent; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing these Liability Release Waivers as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. *

If you are human, leave this field blank.