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Webmaster: Cris Mendoza-Howell |
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Central Valley Dance Festival |
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Central Valley Dance Presents |
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Last Updated:May 17, 2008
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2008 Waiver Form |
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Last Name:
First Name:
Email Address:
Address:
City: State:
Zip: Phone:
In case of emergency, contact
Relation to participant
Emergency Phone Number
I realize that no medical insurance is provided for by Cristina Mendoza-Howell at the Central Valley Dance Conference 2008, which will be held on October 18th and 19th, 2008 At the Fresno Memorial Auditorium located at 2425 Fresno Street, Fresno, CA 93727 and agree to assume the risk for any injury related to my participation or the participation of my dependent (children under 18 years of age).
I do hereby release and forever discharge Cristina Mendoza-Howell and Fresno City Parks and Recreation, its staff, employees and volunteers from any and all claim, demands, causes of actions, suits, damages, costs and expenses for any and all personal injuries, loss of time, pain and suffering or property damage arising out of or occurring in connection with my participation in the scheduled event.
I am physically able (or my dependent is physically able) to participate in this activity. I consent to any medical treatment I or my dependent needs while involved in this activity and I agree to pay for it.
I have read and fully understand this document, including the fact that I am releasing and waiving certain potential rights held by me and voluntarily and freely agree to the terms and conditions set forth and I have the authority to sign on behalf of myself and/or my dependent.
Signature of Participant (Parent/Guardian if participant is under 18)
Name of Group if applicable:
Group Director:
Today’s Date:
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