Name *

First Name

Last Name

Date of birth

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DD

YYYY

Phone *

Best way to contact you

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Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

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Emergency Contact *

First Name

Last Name

Emergency Contact Information *

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Photography and Videography Waiver *

I understand that by signing this agreement I give permission for any photos or videos taken of myself or my child, while engaged in activities at the Latin Ballet to be used in promotional materials.

I Agree

Responsibility Waiver *

I am aware the all forms of dance and gymnastics associated with, place unusual stresses on the body and may carry with them the risk of injury. I understand that the Latin Ballet of Virginia or its staff, are not liable in any way for injuries sustained during attendance of the program or any of its functions.

I Agree