Liability Waiver (2008-2009)

Dancer(s) Name

Address

City

Zip

Home Phone

Cell Phone

Parent/Guardian Email Address

Dancer(s) Email Address (optional)

I will not hold Ann or David Buehler, the dance studios, or any staff member financially responsible for any accidents or injuries that may occur while my child(ren) is(are) on the premises at 4240 South Fremont (Springfield) or 629 Spring Park Boulevard (Mt. Vernon) or at any special event that the studio may be attending. Dance is an active sport with inherent risks. This waiver of liability also includes any family or friends who may have temporary custodial care of the child(ren) listed above.

By typing your name below, you are agreeing to the terms set forth in this Liability Waiver, giving full authorization with this electronic signature.

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