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Students First Name *

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Withdrawal Policy: Any payments upon booking are Non-Refundable. *

I Agree

Please agree to and sign our waiver below to participate.

I, the parent or legal guardian of the daughter/son identified below, do hereby grant permission for my daughter/son to participate in classes, workshops, and activities conducted by Dance Industry Performing Arts Center In order that my daughter/son may receive necessary medical treatment in the event she/he sustains injury or illness during a Dance Industry Performing Arts Center class, workshop, or activity, I hereby authorize Dance Industry Performing Arts Center or its representatives to obtain medical treatment for my daughter/son for any such injury or illness, which treatment may include but is not limited to the transfer or admission of my daughter/son to an area physician office, medical center, or hospital. I hereby hold harmless Dance Industry Performing Arts Center or its representatives from all action taken by them in the exercise of such authority and agree to identify such organization and the persons for any liability, expense, and cost mentioned by them in the exercise of such authority. I understand that participation in Dance Industry Performing Arts Center classes, workshops, and other activities involves a possibility that my daughter/son could sustain or suffer physical injury or illness (minimal, serious, or catastrophic). Knowing the risks of such participation, I acknowledge and agree that my daughter/son is assuming the risk of such physical illness or injury by his/her participation and, on Dance Industry Performing Arts Center or its representatives from any and all claims for personal injury or illness or otherwise that may arise from or relate to my daughter’s/son’s participation in Dance Industry Performing Arts Center classes, workshops, and activities. In addition to the above authorizations, I hereby grant my permission to qualified physicians and medical center and hospital staff members to administer immediate treatment to my daughter/son should she/he become ill or injured. *

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