Dazzlers Fall Dance Clinic - September 29

Manual Dazzlers Dance Team

FALL DANCE CLINIC

     SATURDAY, September 29^th

9:00 am - 1:30 pm

@ Manual Small Gymnasium

ü Kindergarten through 8^th grade

ü Dancers will perform at Manual-Trinity Football Game Oct. 5th @ 7:30 p.m.

ü ONLY $25 If registration & payment received by September 28^th !

ü Fee $30 at door.  includes dance instruction, lunch, t-shirt

ü Checks payable to:

        ‘DAZZLERS BOOSTER CLUB                                                                         4807 Cedar Forest Place, Louisville, KY 40245

 

Dazzlers 2012 Fall Dance Clinic – ENTRY FORM

Dancers Name & Age_________________________________________________________________________

Parent or Guardian name _____________________________________________________________________

Address____________________________________________________________________________________

City________________________________ State_______ Zip_________ Email:__________________________

 Ph# / Cell#__________________ TShirt Size__ (Child: S/M/LG/XL, Adult: S/M/LG/XL)

Emergency contact: __________________  Phone: ________________

 

Dazzlers 2012 Fall Dance Clinic – WAIVER FORM

Dancers Name______________________________________

Please fill out each line completely with all insurance information and signatures.

I, the undersigned parent/guardian of the participant listed below, do hereby give permission for him/her to atend and participate in the Manual Dazzlers Dance Clinic.  I understand that by attending and participating in this event, there is a possibility of physical illness or injury to him/her.  I hereby waive, release and forever discharge any and all rights and claims for damages which may arise against Jefferson County Public Schools, the Manual Dance Team, it’s coaches, sponsors, and Manual Dance Team boosters.  Furthermore, I authorize the directors of the Manual Dance Team to act for me, according to their judgement in any emergency requiring medical attention.

I certify that I have medical insurance on my child that will provide coverage while he/she participates in the 2012  Manual Dazzlers Fall Dance Clinic.

Name of participant__________________ Insurance Co Name___________ Policy #______________

Group #____________

Parent Signature / Date________________________________

 

ANY QUESTIONS CALL Kathryn Cianfoni at   502-290-7651

OR EMAIL kittyc@insightbb.com