DANCE DIMENSIONS
ACKNOWLEDGEMENT AND RELEASE
(MINOR)
Dear Parent:
Please read carefully. Your child will not be allowed to participate in classes until this release is completely filled out and received by the Studio.

The undersigned, being the parent or guardian of _________________________,
(Insert Child’s Name)
a minor, (the “Child”) acknowledges that he/she has voluntarily registered the Child to participate in a dance/exercise program with Dance Dimensions…Dance and Fitness by Jen Naso Inc. (the “Studio”). The undersigned further acknowledges that he/she is aware of no medical conditions of the Child which would impair the Child’s ability to participate in the program and/or which would subject the Child to personal injury or illness.

In addition, as consideration for the Child’s participation, on behalf of himself/herself and on behalf of the Child, the undersigned hereby acknowledges the program requires physical exertion and may cause personal injury, and voluntarily assumes all risk of accident, injury, illness and/or damage to the Child or the Child’s property. Further, the undersigned hereby releases and discharges the Studio, its shareholders, directors, officers, employees, volunteers, owners, and assigns from every claim, liability and/or demand of any kind for or on account of any personal injury, illness and/or damages of any kind sustained, regardless of the cause, including any injury, illness and/or damages resulting from any pre-existing conditions disclosed to the Studio.
Dated this _____ day of _______________, 20 _____, at Strongsville, Ohio.

(Print) Parent or Legal Guardian _____________________________________
(Signature) Parent or Legal Guardian _________________________________
A Minor _________________________________________________________

I grant Dance Dimensions and Fitness by Jen Naso Inc., its agents and employees permission to authorize any emergency medical treatment that may be required for my child during the
current dance session. My medical insurance is offered through:
___________________________ _______________________________________
Insurance Company Name Policy Number

I allow any photos of your child that may be taken to be used for our web page, promotional advertising, or photo boards at the studio

I, the undersigned, have read this release/authorization and understand all its terms. I execute it voluntarily and with full knowledge of its significance.