Registration

Registration fee: $20 (does not apply to camps) Etransfer to jilliangallanteda@hotmail.com

Dancer Name

Mailing Address

Phone Number

Contact Name

Date of Birth

Class

Emergency Contact Name and Number

Medical Information (ie allergies, etc)

Declaration by Parent/Guardian

I waive any and all claims I may now and in the future have against, and release from all liability and agree not to sue Encore Dance Academy, their officers, employees, leaders (volunteer or other), agents or representatives (collectively the “released parties”) for any personal injury death and property damages, expenses or loss sustained by me as a result of my participation due to any cause whatsoever, including, without limitation, negligence, breach of statutory duty including duties arising from occupier’s liability legislation, on the part of released parties.