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Middle School Dance Party Registration Form

Student's Name *
Student's Name
Parent's Name *
Parent's Name
Address *
Address
Phone *
Phone
LIABILITY WAIVER: As a parent (legal guardian) of the above named minor, I grant permission for this minor(s) to participate in all activities of this dance program. I assume all risks and hazards incidental to participating in this dance program. I do hold harmless Our Lady of the Elms, the faculty, staff and any and all other volunteers, participants, and organizers for any claims arising out of injury to my child except to the extent and the amount covered by the accident or liability. MEDICAL RELEASE: I further grant permission for emergency first aid to be given to my child in the case of injury. If necessary, I grant permission for my child to be taken to the emergency room of a nearby hospital, and its staff has my authorization to provide treatment which a physician deems reasonably necessary for the well-being of my child. PHOTO: Our Lady of the Elms reserves the right to take pictures at all events and programs. Pictures may be displayed in brochures, publications and social media.