Student's Name *

First Name

Last Name

Parent 1 Name *

First Name

Last Name

Parent 2 Name

First Name

Last Name

*

I choose to have my child participate in dance instruction at Queens School of Ballet. I acknowledge that I understand the nature of the activities my child will be participating in and the possibility that despite precautions, accidents and/or physical injury may occur.

*

I/we agree to release and hold harmless Queens School of Ballet, including teachers and staff members from any cause of action, claims, or demands now and in the future. I/we will not hold Queens School of Ballet liable for any personal injury or any personal property damage or loss, which may occur on the premises before, during or after classes, or which may occur at any Queens School of Ballet sponsored event outside the studio.

*

I have read Queens School of Ballet's policy page (including dress code) and I agree to follow all QSB's policies.

*

Photographs and film taken by Queens School of Ballet may be used in print and digital platforms for brochures, Queens School of Ballet's website, and other promotional materials produced, used by, and representing Queens School of Ballet. It is understood that there would be no compensation for this use.

*

By typing my name below, I hereby state that I have carefully read the above waiver. Acceptance and understanding of this agreement are hereby acknowledged.

Parent/Guardian *

First Name

Last Name

Today's Date *

MM

DD

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