Summer Registration

Camper's Name *

First Name

Last Name

Age *

MM

DD

YYYY

Camper's Cell Phone

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Cell *

(###)

###

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Acknowledgement *

By checking this box, each student and parent or guardian hereby recognizes the inherent risk of injury associated with the art and sport of dance. As such, and in consideration for the mutual benefits received stemming from this contract as a whole, parents, guardians, and students hereby assume the risk of injury associated with dance and agree to hold harmless Westend Dance Company LLC, it’s officers, instructors, heirs, successors, or assigns from any injury occurring in the course of dance or any injury occurring as a result of misbehavior of the student. Also all payments are due and must be paid in full. There are no refunds of services or products. This is a legally binding agreement and you are directed to seek legal counsel if you do not understand its contents. I have read the above agreement and understand it in its entirety. My child(ren) and I agree to follow the terms of this agreement.

If you have acknowledged the statement above, please check here.

I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.

Parent/Guardian's Signature

First Name

Last Name

Date

MM

DD

YYYY