Waiver

All students are required to complete this waiver form prior to taking a dance class.

Student’s Name:
Student's Age:
Address:
City:
Zip code:

Parent’s Name:
Phone
(home):
(cell):
(work):

Email address* (required for critical school communications):

Who should be contacted in case of an emergency or class cancellation?
Name:
Phone:

Please list any medical conditions your child may have:





The undersigned understands that the Westford Studio of Ballet Arts is accepting me, or my child, as a student. I realize that there are certain dangers possible in the art of dancing. I agree to assume the risk of all injuries or damage that may arise from my, or my child’s, participation in the dance activities at the Westford Studio of Ballet Arts.

I certify that I or my child, is in proper physical condition to take part in dance activities. In consideration of the above, I hereby release and hold harmless the Westford Studio of Ballet Arts and their teachers, or director, or any agents from and against any liability or claim for any injury, misadverture, harm, loss, cost or damage sustained of my, or my child’s, participation in the Westford Studio of Ballet Arts classes or activities.

I have read this release and understand its meaning.





Signature of Parent/Adult Student:
Date: