Dancer Name *

First Name

Last Name

Dancer Date Of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Liability Waiver* *

* I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Distinction Dance Company's classes, rehearsals, performances, or activities. Distinction Arts Company, LLC (Distinction Dance Company) nor it's owner, directors, teachers, instructors, staff members, guest teachers, choreographers, volunteers, nor associates shall be held Liable for any illnesses or injuries that occur during but not limited to classes, rehearsals, events, Distinction Dance Intensive, Summer Summit at DDC, or any other workshops, classes, or events held at Distinction Dance Company. Registration submissions are permanent and fees are non-refundable once paid. By checking the box below you understand the aforementioned statements and are in agreement.

I have read the above and I Agree.

Photo/Video Release* *

I give permission to Distinction Arts Company, LLC to use my/ my child's name and photographic likeness in all forms and media, whether electronic, print, digital or electronic publishing via the Internet for advertising, trade, and any other lawful purposes.

I Agree.