Adult Consent Form

Please complete the following:

Do you have special needs, injuries, previous injuries/operations, or anything we may need to be aware of?

Emergency contact detail – Please provide at least two numbers:

Please confirm that you have read and agree the the following:

I give permission for the named above to participate in Mini Professionals Dance Academy classes run by Principal Bethany Gorton and associated teachers. I realise that participation in this activity involves risk of injury. I hereby waive and release Bethany Gorton and all teachers, instructors, volunteers and employees from any and against all claims of liability including accidents, injury or death.

I, the undersigned, hereby grant permission to Bethany Gorton and Mini Professionals dance teachers to photograph and/or record on video and to use this material in whole or in part, to promote Mini Professionals Dance Academy. I understand that the material will remain property of Bethany Gorton and associated teachers and will only be used to promote the academy. I further waive any claim to remuneration for material used for these purposes.

Where did you hear about Mini Professionals Dance Academy?

If Other - Please State Where.