Registration
ULTIMATE DANCE ON THE MOVE- Liability waiver Please complete in order to be able to participate in events & classes at one of our locations. All students must have an updated liability waiver on file & if you are looking to schedule your child's introductory class please call and schedule it with the studio ahead of time as intro trial classes are not always available . (630)809-2010
Event:
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Family Information
First Name:* Last Name: *
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Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
What event/class are you signing the liability waiver for?
 
Additional Information:
 
Liability Waiver
As the legal parent or guardian, I release and hold harmless Ultimate Dance On The Move LLC, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant while in or upon the premises or any premises under the control and supervision of Ultimate Dance On The Move LLC, its owners and operators or in route to or from any of said premises.

I realize that participation in dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the participant and parent/guardian) assume all risks related to the use of any and all spaces used by Ultimate Dance On The Move LLC.

I agree to release and hold Ultimate Dance On The Move LLC, including its teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I will not hold Ultimate Dance On The Move LLC liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I (and/or the Participant) agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Ultimate Dance On The Move LLC.

I fully understand my right to review this Release and Waiver, and have carefully read and fully understand all the provisions of this Release and Waiver, and am freely, knowingly and voluntarily entering into this Release and Waiver.

I've read the above and agree.
 
Picture Release
I give Ultimate Dance On The Move LLC my permission for the public display of pictures and or video of my child for possible advertisement purposes (i.e. brochures, newspaper ads, web site, etc. - no names will be used).

I fully understand my right to review this Release and Waiver, and have carefully read and fully understand all the provisions of this Release and Waiver, and am freely, knowingly and voluntarily entering into this Release and Waiver.

I've read the above and agree.
 
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