Midwest Dance Center Participation Form & Waiver

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We're so glad you're joining us for classes at Midwest Dance Center! Please fill out this waiver before the start of your child's class.

Email *

Parent's First and Last Name *

Child's First and Last Name *

Child's Birthdate (Month, Day, Year) *

I understand that all events and classes at MDC are currently drop-off only. I understand that my child must wear a mask at all times when in the studio. If you do not have a mask, MDC will supply one for you. Children will be guided by instructors to follow physical distancing protocols at all times and to sanitize regularly. You can view our Safer Studio™ guidelines and all policies at MidwestDanceCenter.net/Safer-Studio *

I agree.

I would like to receive occasional emails from Midwest Dance Center *

Yes, sign me up!

Not right now, thanks!

I understand that Midwest Dance Center, LLC is not responsible for lost items, stolen items, or unclaimed merchandise. I understand that participation in a dance program involves risk and possible injury. I understand that Midwest Dance Center, LLC and its staff will not be held responsible for injuries sustained in class, while performing, or traveling to or from its facilities. I authorize Midwest Dance Center, LLC to secure any emergency treat my child might need. I grand Midwest Dance Center, LLC irrevocable permission to use my child's image and visual likeness in all forms and media for advertising, true, and any other lawful purpose. I agree that all right, title and interest and to all such images and any reproductions or derivative works shall be the exclusive property of Midwest Dance Center, LLC. I agree that Midwest Dance Center, LLC does not owe me any compensation for the acts that I have consented to in this section. I hereby release Midwest Dance Center, LLC from all liability or legal responsibility that may arise from the acts that I have authorized or consented to herein. I have carefully read and understand the terms and conditions of this section. (required) *

I accept

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