Dance With Carmen Registration Form
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Email *
Last Name, First Name (Student) *
Last Name, First Name (Parent/Guardian) - N/A if older than 18 years
Address *
Phone number *
Registering for the following class: *
Required
Day
Time
Class Format *
Class fee $10.00 *
Required
I, ______________________, hereby agree to hold Dance With Carmen (Carmen Melendez) free and harmless from any loss, damage, liability, cost or expense that may arise. It is my responsibility to notify Carmen Melendez of any cancellations or revisions in terms of choreography, rehearsals or anything related to the services Dance With Carmen provides and shall be addressed using discretion. I, ______________________, hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein I and or My Child(s)’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless Dance With Carmen (Carmen Melendez) from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of Myself or My Child’s  pictures, digital images or videotapes, including publication on the internet, in brochures, or any other advertisements or promotional materials. *
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