(Please use a separate form for each child and
for each class)
Use "TAB" key to move between fields.
Choose the week you would like your child to attend.
Acknowledgment of Risk,
Waiver of Liability and Photo Disclaimer:
As parents or legal guardian of (name of child)
I hereby consent to aforementioned participating dance and related activated
with ABAKA. I recognize that potentially injuries can occur at any activity
involving motion, including dance and related activities. I understand
it is the express intent of ABAKA to provide for the safety and protection
of my child and in consideration for allowing my child to use these
facilities, I hereby forever release ABAKA, its officers, employees,
and teachers for all liability for any and all damages suffered by my
child while under the instruction, supervision or control of ABAKA or
its employees. As parent or legal guardian of the aforementioned person,
I hereby agree to individually provide for the possible future medical
expenses, which may be incurred by my child as result of any injury,
sustained while participating in dance class or related activities at
ABAKA. This acknowledgment of risk and waiver of liability, having been
read through thoroughly and understood completely, is signed voluntarily
as to its content and intent. By signing this form, I agree to
allow my child/children's images to be used on Abaka website or
other media. If you do not want your children's images to be
used, you must mail
a certified letter stating
your disagreement to the photo policy.
BY CHECKING THIS BOX, I CONFIRM THAT I HAVE READ AND AGREE WITH THE "ACKNOWLEDGEMENT
OF RISK AND WAIVER OF LIABILITY".
PLEASE ENTER THE IMAGE CODE BELOW!
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