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Birthday Party Release Form

Grassland Dance Academy
Release of Liability

In consideration of my/my child’s participation in classes at Grassland Dance Academy, I understand there are certain risks of injury associated with, arising out of and inherent to the activity of dance and I am willing to assume these risks on behalf of the participant.

    I hereby certify that I/my child am/is capable of participating in the classes of Grassland Dance Academy.

    I further accept all risk to my/my child’s health and of my child’s injury or death that may result from such participation and I hereby release Grassland Dance Academy, its officers, employees and other representatives from any and all liability to me/my child for any and all claims and causes of action for loss of or damage to my/my child’s property and for any and all illness or injury to my/my child’s person, including death, that may result from or occur during my child’s participation in classes at Grassland Dance Academy, whether caused by negligence of Grassland Dance Academy, its officers, employees, representatives or other third parties.

I have carefully read this agreement and understand it to be a release of all claims and causes of action for my/my child’s injury or death or damage to property that occurs while participating in classes at Grassland Dance Academy.

November 14, 2024

 

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Today's Date: *

Child Age:
Are you interested in dancing with GDA?*
Yes
No

Event attending today: *
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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