Dance Ministry Liability Waiver

Dance Ministry Liability Waiver
Please complete this form to participate in our Dance Ministry activities. Your safety and understanding are important to us.
Participant Full Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any medical conditions, allergies, or physical limitations we should be aware of
Are you under 18 years of age?
Parent/Guardian Name (if participant is under 18)
First NameLast Name
Signature (Participant or Parent/Guardian if under 18)
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