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Bring-A-Friend Week Registration

Release Form:

  1. Any limitation in ability to participate due to a medical condition must be noted on this form. Failure to note such a condition is warranty by the parent that such a condition does not exist.  Limitations (type "none" in the signature box if none exist):
  2. I,
    , hereby release valley dance theatre, llc, from any and all liability. I understand that my child and/or I will be participating in a physical activity, and as such, I realize there is an element of risk involved. I allow valley dance theatre to take photos of my child that may be used for publicity purposes.


Please select who will be participating...
AdultMinor
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First Participant Name
First Name*
Last Name*
Phone*
First Participant Age Acknowledgment*
First Participant Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant Information
What is the name of the Current VDT student you will be attending with? *
What class will you be attending? (Day and Time) *
Have you ever taken a dance class before?*
No
Yes
Are you interested in learning more about our programs?*
No
Yes
First Participant Signature*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
What is the name of the Current VDT student you will be attending with? *
What class will you be attending? (Day and Time) *
Have you ever taken a dance class before?*
No
Yes
Are you interested in learning more about our programs?*
No
Yes
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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