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Powerhouse Dance Alliance
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LOG IN / Register
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PDA Release Waiver
Release of Liability & Photo Release
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Dancer's Name
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Last
Parent/Guardian’s Name
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Medical Insurance Company & Group Number
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Physician’s Name
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Physician’s Phone Number
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Waiver Agreement
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I accept the terms of service below
I am aware that dance places an unusual stress on the body and carries with it the risk of physical injury. On behalf of my child and myself, I assume the risk and agree that Powerhouse Dance Alliance, LLC, its owners, Faculty, Staff, or any of its chaperones and agents shall not be liable in any way for any injuries sustained or loss of property during the attendance at Powerhouse Dance Alliance or any events related to Powerhouse Dance Alliance, including without limitation related to travelling to and from Powerhouse Dance Alliance and events related to Powerhouse Dance Alliance. My child has my permission to be treated for emergency medical care.
I give my permission for photographs, video, or television footage which includes my child to be used for promotional purposes on television or in newspapers, brochures, websites, or any other media.
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