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Registration

Photography consent & release form

Date of birth

Health declaration

Please fill out the following form.

Date of birth
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes

West Valley Dance Studio 

Waiver of Liability and Hold Harmless Agreement 

I realize that participation in dance activities could involve possible personal injury, and that despite precautions, accidents and injuries may occur. I am fully aware of the risks connected with this activity, including but not limited to travel risk and/or dance. By signing this release form, I assume all risks, including loss or injury, related to participation in any and all West Valley Dance Studio activities. I agree to release and hold harmless West Valley Dance Studio, including its instructors, dancers, staff members, and facilities used for any cause of action, claims, or demands now and in the future. I will not hold West Valley Dance Studio liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. 

In case of an accident or illness, I give my permission to receive emergency medical or surgical treatment. I understand every effort will be made to contact the parent/guardian (if the dancer is a minor) or the emergency contact  

Furthermore, I agree to obey the class and facility rules, I agree to take full responsibility for behavior and any damage I may cause to the facilities utilized by West Valley Dance Studio.  

I have read and agree to all of the above.

Date
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