REGISTRATION FORM FOR TAP DANCE CLASS with BUSTER COOPER
| Name: ____________________________________________________________________ | |||||||||||||||||||||
| Address: _______________________________________________________________________ | |||||||||||||||||||||
| City: ________________________________ State __________ Zip ____________ | |||||||||||||||||||||
| Phone: (Day) __________________ (Evening) ________________ | |||||||||||||||||||||
| Please check age range: 8-12 years: ___ 13-18 years: ___ Over 18: ___ | |||||||||||||||||||||
| How many years have you studied Tap Dancing? ____ How many days a week do you dance? _____ | |||||||||||||||||||||
| PLEASE SIGN THIS WAIVER OF LIABILITY | |||||||||||||||||||||
| I,
the undersigned in consideration of participating in the Tap Festival
sponsored by NTCC on April 27, 2002, for myself, the student and legal
representative, heirs, administrators, executors, and assigns of either
of us, hereby release and discharge NTCC, it's officers, directors,
members and persons employed or engaged by it, for all liabilities,
known or unknown, growing out of the student's said participation and
including but not limited to bodily injuries, and loss or damage or
property. I am aware the participation in dance activities and performance may give rise to personal injury. I am voluntarily taking part in such activities with that knowledge and I agree to accept all risks arising therefrom. After carefully reading the foregoing, I understand that it is a contract intended by all parties to be as broad and inclusive as the laws of Texas permit and that if any part is held invalid, the balance shall continue in full force and effect. I have executed this release on the _____ day of _______, 2002 |
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| Signature of DANCER OVER
AGE 18: ________________________________________________ or DANCER UNDER AGE 18: Name: ___________________________________ Signature of Parent or Guardian: ____________________________________________ Enclosed is my check for $20: _____ Or here is my credit card information: |
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| Mail to: Ann T. Reeves, Manager Tap Festival at NTCC 237 Quitman Pittsburg, TX 75686 Questions: Ann Reeves
903-856-3450 |
Card Number:
Expiration |
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| ___________________ ____________________ Signature Name on card |
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