Northwest Alabama Dance/Twirl
Students Name:___________________
Student Age:___________
Class: (please circle) dance, dance/twirl, twirl
Class Times:_____________________
Students Address:_________________
Parents Name:_____________________
Phone Number:____________________
Cell Phone Numbers:________________
In consideration of my child’s participation in the Northwest Alabama Twirlers, I do herby, for myself, my child, my heirs and executors, waive release and forever discharge all rights and claims which may hereafter accrue to me or my child against Nina Rae Long and its employees, and the Northwest Alabama Dance/Twirl Studio, and all injuries and or damages which may be suffered by my child in connection with my child’s dependant participation. I have read and understand the release and waiver of claims statement and fully agree with the provisions of this document.
Parents Signature:________________
Date:________________
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