Defying Gravity Summer Intensive Registration Form Student Name: Phone Number: Text Messages Okay? Y/N. Course: Beginning Course Tank top size: Child: XS 9S ML XL Adult! XS SoM L XL Pricing: $90.00 Amount paid Method. Check #. Due by May Ist to receive the free t-shirt. |understand and agree that in participating in Gravity Dance Center Summer Intensive, there is a possibility of physical injury. | voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Gravity Dance Center's activities. | also exempt, release, and indemnify Gravity Dance Center, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury to my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Gravity Dance Center. | further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Gravity Dance Center, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, or injury. If | am signing this waiver for my children, | certify that | am the parent or legal guardian and have the right to waive these rights. J understand that photos of my child may be used on the Gravity Dance Center website, blog, Facebook page, or for other marketing campaigns. I understand that I must submit a request in writing if | do not wish for Gravity Dance Center to publish my child’s photos, Thaye read, understood and agree to be bound by the above statement (please print your name, sign & date): PRINT NAMI SIGN: If under 18, parents or legal guardian must sign Receipt (For Cash Payments): Child Name. Amount Paid Staff Signature Please retain for your records as proof of cash payment,