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					                               Thriller Registration Form and Waiver
                      North Eugene Dance Team Dance Middl e School Dance class

                                                     2012-2013

Dancer’s name: _____________________________________________ Dancer’s age: ______________


Dancer’s school ____________________________________________________

Home phone: ______________________ Cell phone: ______________________

Parent or Guardian name(s): ____________________________________________________________

Address: ______________________________________ City: ________________ Zip: _____________

Parent’s e-mail: ___________________________ Dancer’s e-mail: _____________________________

Is there anything special we should know about this dancer? ____________________________

___________________________________________________________________________________

                                               Registration fee is $5

                Cash or Check is okay, please make checks out to North Eugene Dance Team

Liability Waiver: I understand and agree that in participating in any dance class, workshop, rehearsal or
performance, there is the possibility of physical injury. I agree, therefore, to assume all risks of any such injury to
myself, or my minor child, which might occur during any and all of North Eugene High School classes,
workshops, rehearsals or performances. I also agree to assume all risks of any such injury to myself, or my minor
child, while traveling in vehicles to event locales, including provided transportation and carpools. I exempt, release
and indemnify North Eugene HS, its members, agents, employees, guest artists and faculty members from any and
all liability claims, demands or causes of action whatsoever from any damage, loss or injury to me (or my minor
child) or my (or my minor child’s) personal property which may arise out of or in connection with participation in
any classes or activities conducted by North Eugene HS, whether such loss, damage or injury results from the
negligence, passive or active, of North Eugene HS, its members, agents, employees, guest artists or faculty members
or from some other cause.

_______________________________________________ ______________________________
Signed (Legal guardian or student, if 18 or older) Today’s date

				
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