Parent First Name
Parent Last Name
Phone
Parent Email
Alternate Parent Name
Alternate Phone
Alternate Parent Email
Street Address
City
State
Zip
Dancer First Name
Dancer Last Name
Dancer's Email
Date of Birth
What race best describes your dancer
African American
American Indian
Asian
Native Hawaiian
Pacific Islander
White
School Grade attending during the show
Name of School Dancer Attends
Emergency Contact Name (if different from Parent(s))
Emergency Contact Number (if different from Parent(s))
Allergies
Dance Home Studio
Years of Dance
Years on Pointe
Injuries/Conditions that may affect student's dancing
Click "Next" if no further dancers
Dancer 2 First Name
Dancer 2 Last Name
Dancer 2 Email
Dancer 2 Date of Birth
Dancer 2 What race best describes your dancer
African American
American Indian
Asian
Native Hawaiian
Pacific Islander
White
Dancer 2 School Grade attending during the show
Dancer 2 Name of School Dancer Attends
Dancer 2 Emergency Contact Name (if different from Parent(s))
Dancer 2 Emergency Contact Number (if different from Parent(s))
Dancer 2 Allergies
Dancer 2 Dance Home Studio
Dancer 2 Years of Dance
Dancer 2 Years on Pointe
Dancer 2 Injuries/Conditions that may affect student's dancing
Click "Next" if no further dancers
Dancer 3 First Name
Dancer 3 Last Name
Dancer 3 Email
Dancer 3 Date of Birth
Dancer 3 What race best describes your dancer
African American
American Indian
Asian
Native Hawaiian
Pacific Islander
White
Dancer 3 School Grade attending during the show
Dancer 3 Name of School Dancer Attends
Dancer 3 Emergency Contact Name (if different from Parent(s))
Dancer 3 Emergency Contact Number (if different from Parent(s))
Dancer 3 Allergies
Dancer 3 Dance Home Studio
Dancer 3 Years of Dance
Dancer 3 Years on Pointe
Dancer 3 Injuries/Conditions that may affect student's dancing
I, the undersigned parent/guardian of the above-named student (the “Student”), hereby consent to the participation of the Student in all activities of West Michigan Youth Ballet Company (“WMYBC”). I understand that any student dancer participating in WMYBC takes certain risks including, but are not limited to strains, pulled muscles, and broken bones. Participation in WMYBC constitutes acceptance of such risk. WMYBC and its officers, staff, board members and volunteers (collectively, “Representatives”) take no responsibility for any personal injury or any injury to or loss of property. Knowing the risks associated with participation in WMYBC, I, ON BEHALF OF MYSELF AND THE STUDENT, ASSUME ALL RISKS AND RESPONSIBILITIES ASSOCIATED WITH SUCH PARTICIPATION, RELEASE WMYBC AND ITS REPRESENTATIVES FROM ANY SUCH RISK AND RESPONSIBILITIES, AND AGREE TO HOLD HARMLESS AND INDEMNIFY WMYBC AND ITS REPRESENTATIVES AGAINST ANY PRESENT OR FUTURE CLAIM, CAUSE OF ACTION, LOSS, OR LIABILITY ARISING FROM OR RELATED TO ANY ACTUAL OR ALLEGED PERSONAL INJURY OR DAMAGE TO OR LOSS OF PROPERTY THAT OCCURS (A) DURING OR AS A RESULT OF ANY WMYBC DANCE CLASS OR PERFORMANCE, (B) IN CONNECTION WITH STUDENT’S PARTICIPATION IN WMYBC, OR (C) OTHERWISE AT WMYBC’S FACILITIES.
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