Name *

First Name

Last Name

Phone *

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Class *

Select class(es) with a checkmark.

Ballet

Jazz

Monday Tap

Tuesday Tap

PLEASE READ CAREFULLY BEFORE SUBMITTING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. * For and in consideration of the above named child's participation in the programs offered by LaVerne Meier School of Dance, the undersigned, individually and on behalf of the undersigned’s child, personal representatives, successors and assigns, hereby waives, releases, forever discharges, indemnifies, hold harmless and will defend J + J Dance LLC, dba LaVerne Meier School of Dance, including but not limited to Jaana Schweitzer and any employees, agents, volunteers, heirs, personal representatives and assigns (“Owners”) of, from, and against any and all liability, claims, actions, causes of action, suits, expenses, including reasonable attorney’s fees, cost, loss, damages, and demands of any kind of nature, known or unknown, foreseen or unforeseen (“Loss”) sustained by the undersigned’s child, which may be caused, directly or indirectly by the child’s participation in the programs, the negligence of Owners or other persons, or some other cause. In addition, I hereby release the undersigned’s child’s image to be used in videos and photos for marketing purposes. *

I have read and understand the above agreement.