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Summer 2021 Covid Safety &

Distancing Liability Release

Form

 

At Step 1 Dance 2 Academy , we are following strict

social distancing + cleaning protocols. As any other

public place we cannot guarantee that your child will

not be exposed (whether at Step 1 Dance 2 Academy or

elsewhere) or if exposed, that your child will not

contract the disease.

2021 Covid Safety &

Distancing Liability Release

Form

I adhere to the safety protocols listed by

Step 1 Dance 2 Academy.

By signing this form in addition to our

general studio liability form you agree to

waive any claims of liability against Step 1

Dance 2 Academy and to hold Step 1 Dance

2 Academy harmless if your child contracts

COVID-19 despite our best efforts to

prevent it. Additionally, I agree to notify

Step 1 Dance 2 Academy if my child or any

member of our household contracts COVID-

19 or has come into contact with someone

who tested positive for COVID-19. This

action will help ensure the utmost safety

of our dancers & staff.

Child's Name____________________________

Parent's Printed Name___________________

Parent's Signature__________________________

Date_______________________________________

First Dancers/Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Dancers/Participant's Date of Birth*
First Dancers/Participant's Signature*
Second Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Second Dancers/Participant's Date of Birth*
Third Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Third Dancers/Participant's Date of Birth*
Fourth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Fourth Dancers/Participant's Date of Birth*
Fifth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Fifth Dancers/Participant's Date of Birth*
Sixth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Sixth Dancers/Participant's Date of Birth*
Seventh Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Seventh Dancers/Participant's Date of Birth*
Eighth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Eighth Dancers/Participant's Date of Birth*
Ninth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Ninth Dancers/Participant's Date of Birth*
Tenth Dancers/Participant's Name

First Name*

Middle Name

Last Name*
Tenth Dancers/Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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