Waiver & Disclosure


Oct 18, 2019 12:40 AM



Waiver & Disclosure



In consideration of my (and/or my child’s) participation in this activity, I hereby release and discharge the Organization, and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I (he/she) may suffer as a result of my (our) participation in this activity. I (we) also will follow the rules and regulations set by the Organization and above named parties.

Parent or guardian must sign for anyone age 18 and under. I do hereby grant and give these groups the right to use my or my child(s) photograph or image in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto.



Parent/Guardian Signature
By signing the bottom of this registration form, you are agreeing to the terms and conditions, legalities, responsibilities of payment, and policies provided by Akademy Funktion Dance Collective LLC.


Print Name: ______________________________________________________ Date: _____________

Signature: ___________________________________________________________________________