Fill out the form below to receive your free lesson!
Please provide the info for an emergency contact. Info should be someone other than parent/guardian listed above
As the legal parent or guardian, I release and hold harmless Texarkana Dance Academy, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, injury, or illness including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or in route to or from any of said premises. I understand that appropriate physical contact is required during the instruction of dance, and I give permission for instructors to make appropriate physical contact with me or my child for such instruction.
As the legal parent or guardian, I give permission to Texarkana Dance Academy, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health.
In conjunction with my participation I give permission for Texarkana Dance Academy to take and use photos and/or video images of me or my child without remuneration in connection with studio publications, website, social media, and advertising.
