Parent/Guardian Name *

Parent/Guardian Last Name *

Emergency Phone *

Parent/Guardian Email *

Student First Name- Friend who is trying the class *

Friend's First and Last Name- current MYM student *

Friend's Last Name-current MYM student *

Please agree to and sign our waiver below to participate.

Liability Release: I acknowledge and understand the nature of physical activities, I understand accidents and/or physical injury may occur. I acknowledge that I could come into contact with germs and bacteria at dance class. I agree to participate at my own risk. I agree to release and hold harmless all parties involved, including any and all staff members from any cause of action, claims, or demands now and in the future. I will not hold this studio as a whole or its staff liable for any personal injury, catastrophic injury or any personal property damage or loss, which may occur on the premises before, during or after classes. *

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