Grey Bruce School of Dance
224 7th Ave Unit #3 Hanover Ont N4N 2H1
info@greybrucedance.com
GBSD Waiver and Release Form
Name of Child (Please Print):_______________________ Today's Date:_______________________
Name of Parent(s) (Please Print):_______________________________________________________
Parent(s) Contact Number:___________________________________________________________
Emergency Contact Name & Number:__________________________________________________
Waiver and Release Statement
I recognize the risk of illness and injury inherited in participating in any recreational activities,including dance. I am allowing my child to participate upon the express agreement and understanding that I, for hereby, for myself, my child and/or heirs, executive and administrators, waive and release any and all rights and claim for the damage I and/or my child may have against Grey Bruce School of Dance and/or the current property owner, their officers, directors, agents,subsidiaries, parents and employees, representatives, successors and assigns for any and all injuries suffered by my child during the program and/or activities. I give my permission for facility personnel to deliver to or call for a doctor, ambulance, or some designated person in case of an emergency. I hereby execute and deliver this waiver and release statement to induce Grey Bruce School of Dance and the current property owner, their officers, directors, agents, subsidiaries, parents, employees, representatives, successors and assign to permit my child, name below, to partake in the program and/or activities.
Parent/Guardian Signature_______________________ Today's Date:_________________________
GBSD Signature:_______________________________ Today's Date:_________________________
