Permission/Injury
Kathy's School of Dance
Curwensville, PA 16833
814.236.1381
I acknowledge/understand that in participation in this class, there is a possibility that my daughter/son may sustain physical injury (minimal, serious or catastrophic) in connection with his or her participation.
I further acknowledge and understand that my daughter/son is assuming the risk of such physical illness or injury by participating, and I release Kathy Bloom (Kathy's School of Dance), and the property owners from any claims for personal injury.
I further acknowledge and understand that I will be responsible for any medical bills that may be incurred in behalf of my daughter/son or physical illness or injury he/she may sustain.
I, the undersigned parent or guardian, do hereby grant permission for my daughter/son,
________________________ to participate in classes. In the event of injury or illness, I hereby hold Kathy's School of Dance harmless in the exercise of this authority.
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Parent or guardian signature Student signature
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Address City, State, Zip Code
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