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preREGEN for dancers 12+ (exceptions made by director)

VENMO PRICE - $40.00

IF PAYING THROUGH VENMO PLEASE DO NOT CHECK A BOX BELOW - SUBMIT FORM WITHOUT CHECKING BOX

PLEASE MAKE PAYMENT ON VENMO TO @brianstevensdance

“Regeneration Class / Company” is filed under Brian Stevens Dance LLC.

IN SUBJECT PLEASE WRITE "DANCER'S NAME & DATE OF CLASS"

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CHECK BOX IF PAYING BY CREDIT CARD

PHOTO/VIDEO RELEASE

I, as the parent or legal guardian, grant Regeneration Class / Company my permission to use the photographs and videos described as photos and video footage of dancers from Regeneration Class / Company classes for any legal use, including but not limited to: publicity, copyright purposes, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

INJURY WAIVER

I, as the parent or legal guardian, acknowledge that participation in Regeneration Class / Company classes expose you to a possibility of personal injury. I, being fullly aware that participation in the program exposes you to possible risk of personal injury, hereby release Regeneration Class / Company, Director, Brian Stevens, and Dance Industry Performing Arts Center from any and all liability from personal injuries.

I acknowledge that I have read and fully understand the Injury Waiver. This agreement shall be binding on myself, my spouse, my children and legal representatives.