Disclaimer – Dance Hub SA

DISCLAIMER FORM

PARTICIPANTS CONTACT DETAILS *

PARTICIPANTS CONTACT DETAILS

First Name

Last Name

Email Address *

EMERGENCY CONTACT DETAILS

Parent/Guardian Name (if under 18) *

Emergency contact name: *

Relationship to participant *

Parent, sister etc

Contact phone number *

MEDICAL INFORMATION

Do you have any medical conditions we need to be aware of? Please state any allergies, injuries, medical conditions and medicines you carry to address any conditions *

SPECIAL NEEDS

Do you have any special needs? If so what aids do you require to support your special needs? If unsure please discuss with us prior to your participation.

PARTICIPATION

In any of our workshops appropriate touching in order to correct a participant may be used. If you do not want to be corrected in this manner please mark this box and the teacher will be notified prior to the workshop.

DISCLAIMER

I acknowledge that participation in the workshop involves the risk of personal injury. Whilst LWDance Hub takes all reasonable care in the conduct of its workshops, it accepts no responsibility for injury or loss caused during a session or whilst participants are at or near the dance studio. You are responsible for ensuring that you are physically and medically fit for the work and during participation you must take care of your own personal safety at all times.

I am aware and that photographs and videos of participants may be taken for promotional and archival purposes only. All material recorded during the program is the copyright of the LWDance Hub.

DECLARATION

The following Declaration must be completed by the participant in the workshop and such participant must be over the age of 18. If the participant is under the age of 18 the Declaration must be completed by the participants’ parent/legal guardian.

BY CLICKING THE SUBMIT BUTTON I CONFIRM THAT I HAVE:
• read the information contained above, including but not limiting to the ‘Disclaimer’
• Answered each & every question fully and frankly
• Provided all reasonable & relevant information.

If anything happens during my participation in the workshop that alters any information I have provided, I will promptly inform the workshop leader.