Name of Dancer *

First Name

Last Name

Birthdate of Dancer

MM

DD

YYYY

Name of Parent/Guardian 1 *

First Name

Last Name

Phone of Parent/Guardian 1

(###)

###

####

Name of Parent/Guardian 2 *

First Name

Last Name

Phone of Parent/Guardian 2

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Classes Dancers is Taking *

Barbie Ballerinna Summer Workshop (Ages 4-10)

Jungle Groove Summer Workshop (Ages 4-10)

I release Rocky Mountain Ballet Theatre, a Montana nonprofit corporation, its Board of Directors, adult supervisors and the respective officers, employees, volunteers and agents from any and all liability resulting from events beyond their reasonable control. In the event of an accident, injury or illness, I understand that RMBT, the adult supervisors and their respective directors, officers, employees, volunteers and agents do not assume any responsibility or obligation to provide financial assistance or other assistance including but not limited to medical, health, or disability insurance, in the event of an accident, injury, illness, death or property damage. In the event of an accident, injury or illness, RMBT and the adult supervisors will make every effort to immediately contact parents/guardians. I release RMBT, the adult supervisors and their respective directors, officers, employees, volunteers and agents from any liability for any loss, personal injury, accident, misfortune, or damage to each participant or his/her property, understanding that reasonable precautions will be taken to ensure his/her health and safety. *

Yes