Registration Form and Waiver

Contact Name (Parent/Guardian/Self) *
Contact Name (Parent/Guardian/Self)
Student's Name *
Student's Name
Student's Date of Birth *
Student's Date of Birth
Friend's Name
Friend's Name
If you were not invited by a friend, please leave blank.
Home Address *
Home Address
Phone *
Select the class you would wish to attend for the week of July 16-19th.
Release *
I hereby represent that I (or my minor child) am physically fit and capable of taking the selected course of dance or acting. I understand and acknowledge that there are certain risks and hazards (including but not limited to broken bones, sprains, etc.) involved with this type of physical activity. I hereby affirm that I expressly assume all such risks and hazards ("Risks"). Further, I HEREBY RELEASE L.A. PERFORMING ARTS (L.A. DANCE & ACTING, LLC) FROM ANY AND ALL LIABILITY RELATED TO THESE RISKS, AND AGREE TO PROTECT, INDEMNIFY AND HOLD HARMLESS L.A. PERFORMING ARTS (L.A. DANCE & ACTING, LLC) FROM AND AGAINST ALL CLAIMS, DEMANDS, CAUSES OF ACTIONS AND DAMAGES, INCLUDING ATTORNEY'S FEES, RESULTING FROM ANY ACCIDENT, INCIDENT OR OCCURRENCE ARISING OUT OF, INCIDENTAL TO, OR IN ANY WAY RESULTING FROM MY (OR MY MINOR CHILD'S) PARTICIPATION IN THE DANCE OR ACTING COURSE SELECTED.
I agree to all of the above *
I agree to all of the above
Enter your full name