|
REGISTRATION AND RELEASE FORM
Registration begins at 1:30. Please print this form and bring it with you.
This form is required to be completed, signed by the appropriate party, and given to a “Joanna A. Nichols Dance for the Cause” representative prior to participation in the Dance-a-Thon.
Registration Information:
| First & Last Name |
Address |
| Phone |
Alternate Phone |
| Age |
Date of Birth |
Release:
In order to participate in the “Joanna A. Nichols Dance for the Cause” Dance-a-Thon, you must read and acknowledge the waiver and release form provided at each participating dance studio. These forms will be provided when you arrive to the location.
In addition, please sign below and acknowledge the waiver and release for “Joanna A. Nichols Dance for the Cause”. Thank you.
Joanna A. Nichols Dance for the Cause – I willingly and acceptingly agree to participate in the “Joanna A. Nichols Dance for the Cause” and attest that I am in the correct physical health to participate and hold harmless this organization and all of its affiliates. I agree to release and discharge “Joanna A. Nichols Dance for the Cause” affiliates and officers from any claims, demands, or liability of damage arising from my participation, or the participation of my child, in this event.
Signature of Participant: _____________________________ Date: __ / __ / ___
Signature of Parent/Guardian: ____________________________ Date: __ / __ / ___
(Parent or Guardian signature required if participant is under the age of 18)
| 
