Kids Fun Night

Child's Age: *

Emergency Contact - Name and Relationship to Child: *

If you answered yes above, please explain...If you answered no, type N/A: *

Email: *

Parent's Name: *

Phone: *

Does your child have any food allergies? *

No

Yes

Emergency Contact Phone: *

Liability Wiaver - I understand that Euphoria Dance Centre is not responsible for any injuries sustained at Kids Fun Night. I recognize that my child’s participation may expose him/her to the risk of injury or harm. I accept this risk and hereby release Euphoria Dance Centre, its officers, directors, staff, employees, independent contractors, volunteer helpers, and landlords from all liability for personal injury, illness, property damage, or property loss, occurring during Kids Fun Night. I certify that my child is in good health and capable of participation in all the activities. Euphoria Dance Centre has my permission to take photos, videos and/or films of my son or daughter and consent to use such materials for promotional purposes by Euphoria Dance Centre. *

by checking this box I agree to the terms of the Liability Waiver stated above and am certain I have filled out all information correctly to the best of my knowledge.

Child's Name: *