Ballroom Release Form
Please review and complete this release form before participating in any ballroom activities. This form outlines important safety information, responsibilities, and liability terms to ensure a safe and enjoyable experience for all participants.
Participant Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Participation Details
Type of Participation
Please Select
Classes
Private Lessons
Workshops
Events
Experience Level
Please Select
Beginner
Intermediate
Advanced
Health & Fitness Acknowledgment
Are you physically able to participate in dance activities?
Yes
No
Any injuries or medical conditions?
Yes
No
If yes, please describe
Final Section
Participant Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: