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Student 1 Information:

Female

Male

Adult

Child

And

Or

And

Or

And

Or

Student 2 Information:

Female

Male

Adult

Child

And

Or

And

Or

And

Or

Student 3 Information:

Female

Male

Adult

Child

And

Or

And

Or

And

Or

Waiver and Release

To the best of my knowledge there are no physical and/or other conditions which will interfere with the participation of the students listed above. As the parent/legal guardian of a participant or the participant in U Can Dance LLC classes at the CAC, I recognize the risks of physical injury inherent in dance classes. I acknowledge and accept those risks. I agree to hold North Cross School and U Can Dance LLC, its officers and agents free and harmless for any injuries or damages arising during participation in this program. By signing below, I have read and agree to these policies and statements. I agree to allow photos of the students listed above to be use on studio advertising. I agree to accept emails and text messages about class information.

By checking here and typing my name, I agree to the terms listed in the paragraph above.

**Convenience fees apply to ACH or credit payments. They will be added to the invoice.

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U Can Dance LLC

4254 Colonial Avenue, Roanoke, VA 24018

Phone: 540-915-7259

Email: sddicken@infionline.net

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