Ballroom Release Form

Get participant authorization and liability release before a ballroom dance event or class.

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Full Name

Nombre

Apellido

Date of Birth

Email Address

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Emergency Contact Name

Nombre

Apellido

Emergency Contact Phone

Relationship

Type of Participation

Experience Level

Are you physically able to participate in dance activities?

Yes No

Any injuries or medical conditions?

Yes No

If yes, please describe

Participant Signature

Sign here

Date

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