MAKING A CHANGE PERFORMING ARTS COMPANY - PARTICIPANTS REGISTRATION

PARTICIPANTS REGISTRATION

To become an participant, you need to register by leaving your name and contact information.

Name:
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Dance Name:
Date of Birth:
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Select Battle Participation:

Address:
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City:
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State:
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Zip Code:
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Country
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E-mail:
Phone
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In consideration of the acceptance of my entry I the undersigned am legally bound for myself my heirs successors and assigns do hereby waive and release Making A Change Performing Arts Company Dance Madness its sponsors host venues and all persons and agencies connected with this competition from all claims for damages arising from my participation in and travel to and from this competition including without limitation personal injury. I certify that I am in good health physically fit and adequately trained to participate in this event. I grant permission to all the above mentioned to use my name photos and likeness for any purpose.
Signature of Participant (18 and over) (Printing Name Represents Signature)
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Signature of Parent/Guardian for Participants under 18 (Printed Name Represents Signature)
*
Date:
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Mailing list signup:
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Security code:
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Do not enter anything in this field:

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