CAMELOT UPPER MARLBORO
13905 CENTRAL AVE
DANCE STUDIO LEVEL M
UPPER MARLBORO, MD 20774
Phone: (301) 575-4465 E-mail: EudoraBallet@msn.com
Dear Dancers and/or Parent(s) (or Guardian),
We put safety as one of our top priorities, and we will strive to ensure each dancers safety. However, accidents
happen, which are sometimes beyond our control. We are asking each dancer (or parent/guardian) to sign the
following liability waiver form.
Please read and sign the following waiver form:
Eudora Ballet/Elisa Batts Liability Waiver Form
I/we realize that participation in Eudora Ballet/Elisa Batts could involve some possible personal injury. Despite
precautions, accidents and injuries can occur. By signing this release form, I/we (meaning the dancer and
parent/guardian) assume all risks related to the use of any and all spaces used by Eudora Ballet/Elisa Batts. I/we
agree to release and hold harmless Eudora Ballet/Elisa Batts, including its teachers and its staff members as well as
the facilities use by Eudora Ballet/Elisa Batts from any cause of action, claims, or demands of any nature
whatsoever, now and in the future. I/we will not hold Eudora Ballet/Elisa Batts liable for any personal injury or any
personal property damage, which may occur on the premises used during the classes. Furthermore, we agree to obey
the Class and facility rules and take full responsibility for any damage I/we may cause to the facilities in use by
Eudora Ballet/Elisa Batts. In the event that I/we should observe any unsafe personal conduct or conditions before,
during or after my/our classes, I/we agree to report the unsafe conduct or conditions to the Artistic Director,
instructor or staff member as soon as possible.
In the event of a serious emergency, I/we understand that the student will be taken to the nearest hospital emergency
room. Should such action be necessary, I/we understand that I/we will be notified as soon as possible and will be
responsible for any incurred charges.
Thank you in advance for your cooperation,
Eudora Ballet/Elisa Batts Staff
Type and/or Print fill able sections. Sign and return document.
Program Spring Summer Fall Year Round
Student’s Name (Print): Age:
Student’s Signature Date
Name (Print): Phone:
Parent’s (Guardian) Signature Date