Athlete Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent / Legal Guardian or Emergency Contact Name *

Emergency Contact does not need to be a parent or legal guardian if athlete is over 18 years old. If athlete is under 18 years old, a parent or legal guardian will serve as the emergency contact.

First Name

Last Name

Emergency Contact Phone # *

(###)

###

####

Liability Release Waiver *

By checking this box, I certify that I am either 18 years or older, or am a parent/legal guardian of a participating athlete and I agree that my son/daughter has my permission to participate in this event. I understand that my, or my son/daughter’s, participation is completely voluntary, and I do not hold the University of Minnesota, Minnesota Dance Team, or any of the staff or other athletes attending this event liable for any injury or damages that may occur in accordance with my son/daughter’s participation. I understand that, under reasonable circumstances, there is some inherent danger in the sport of dance which is unavoidable when performing skills or learning new skills. I accept all liability for my, or my son/daughter’s, participation in the Minnesota Dance Team event.

I Agree