Workshop Registration Form

Student Name *

First

Last

Age *

Parent Name *

First

Last

Phone # *

Address *

Unit, Street, City, Postal Code/Zip Code, Country

Email *

Name Of Your Dance Studio *

Which workshop will your child be attending? *

Comments or Questions

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Medical Conditions/Allergies

Please list any medical conditions or allergies that may be important for us to be aware of.

Liability release *

I am aware that participation in dance activities involves the risk of injury resulting from various causes, including overexertion, defective or unsafe conditions of the facilities or negligence on the part of The Unconditional Movements teachers/staff or other persons using the facilities or participating in the programs. Of my own free will I henceforth accept and fully assume all risks, and in consideration of The Unconditional Movements acceptance of my application to participate in the programmes, hereby:
(a) waive any and all claims that I may at any time have against Unconditional, its shareholders, employees or representatives (collectively the “Releasees”) and release the Releasees from any and all liability for any loss, damage or injury that I or my child may suffer as a result of my or my child’s use of or presence on the facilities or participation in the programs, due to any cause whatsoever, including (without limitations) negligence on the part of the Releasees
(b) agree to hold harmless and indemnify the Releasees from any and all liability for any damage to property of or personal injury to any third party, resulting from my or my child’s use of the facilities or participation in the programs;
(c) I give permission for my child’s photographic image to be used in various forms of media, such as online advertising (website), printed material and related publicity.

Parent Signature *

Please type first & last name.