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Utopia Dance Company Liability, Waiver Form
First Name
Last Name
Email
Date of Birth
Please specify anything we should know about
Initials
By checking here, you are consenting to the use of your electronic signature/initials in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may request, upon written request to obtain a paper copy of an electronic record. No fee required. Your agreement to use an electronic signature with us for any document will continue until such time as you notify us in writing that you no longer wish to use an electronic signature/initial. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
I declare that I have read and agree to the following stated in the Liability Release, Waiver, Discharge and Covenant Not to Sue Terms
View Liability Release, Waiver, Discharge and Covenant Not to Sue Terms
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
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Photo Release
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