Beginner Registration and Liability Waiver Form 2023-24

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Aakriti Kathak Academy - Please fill out for each student

Email *

Student's Full Name *

Whatsapp Contact number *

Email Address *

Student's Date of Birth *

YYYY

Address *

City *

Zip Code *

Parent's Full Name

Primary Contact number *

Please list any allergies or medical conditions we should be aware of *

$100 'Intent to Register' sent via
*

Zelle (aakritikathakdance@gmail.com)

Venmo (@kritirakesh)

Mailed check (1100 Wakehurst dr, Cary NC 27519)

Required

Release of Liability *

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for registered student’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: AAkriti Kathak Academy, NAACHMASALA school of dance and KRITI RAKESH and/or their directors, officers, employees, volunteers, representatives, and agents

Required

Release of Liability *

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE AAkriti Kathak Academy, NAACHMASALA School of Dance and/or KRITI RAKESH from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

Required

Electronic Signature. Please print your name below *

Submit

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