Name *

If student is under the age of 18, please have parent or guardian sign on their behalf.

First Name

Last Name

Waiver of Liability *

There is a risk of injury when participating in activities with Bellingham Repertory Dance. I recognize that Bellingham Repertory Dance offers dance and movement classes and rehearsals that require strength, flexibility, and aerobic exercise. The activities include things that may cause injury. I have been informed of and understand the risk of such an injury, and in consideration for being allowed to participate in activities with Bellingham Repertory Dance do hereby release the company, its employees, and other acting on its behalf from any claims or liabilities for injuries or damages to my person arising from my participation in those activities. I am physically sound. I hereby declare myself to be physically sound and suffering from no condition or impairment that would prevent my sage participation in the physical activities offered by Bellingham Repertory Dance. I agree to keep my teachers informed of changes to physical condition or changes in my ability to perform the activities associated with my participation in classes or other activities. I have had a recent physical examination. I acknowledge that it is recommended that I have a yearly or more frequent physical examination and consultation with my physician regarding physical activity, dance, and exercise. I have either 1) had a physical examination and been given my physician’s permission to participate in Bellingham Repertory Dance’s activities or 2) I have decided to participate in these activities without the approval of my physician and assume responsibility for that participation. In checking the box below, I hereby agree to the above conditions.

I agree

Photo/Video Release

I agree to grant Bellingham Repertory Dance and its authorized representatives permission to record on photography film and/or video my participation activities. I further agree that any or all of the material photographed or video recorded may be used, in any form, as part of any future publications, brochures, and print or online promotional materials including social media outlets. Print and video materials used for Bellingham Repertory Dance shall be without payment of fees, royalties, special credit or other compensation. I hereby release and discharge Bellingham Repertory Dance from any and all claims and demands arising out of, or in connection with, the use of the photographs and video footage, including and without limitation, any and all claims for libel or invasion of privacy. I hereby give my permission for BRD to use photos and/or videos of me for social media, marketing, and promotional purposes.

Yes

No

Friends of BRD

Are you interested in receiving occasional email updates from BRD about upcoming classes?

Yes

No