BERGEN PAC NUTCRACKER AUDITION REG

Bergen PAC NUTCRACKER - Registration Form

Student's First & Last Name

Parent/Guardian's First & Last Name

Street Address

City/State/Zip Code

Phone

Student's Date of Birth

Grade in School

Years on Pointe

Current Dance Studio

Optional Message:

Auditioning for (select date):

Clowns 9/28 @ 4:00PM

Clowns 9/29 @ 5:00PM

Assumption of Risk, Liability Waiver and Indemnification: I understand and agree that participation in any class, lesson, workshop, rehearsal, performance or other activity conducted by New Jersey Ballet Company, Inc. or NJ School of Ballet, LLC (together, New Jersey Ballet) poses the possibility of injury, loss, damage or death. I agree, therefore, to assume, all risks and responsibility for any such injury, loss, damage or death which might occur to me (or my child) by reason of any New Jersey Ballet class, lesson, workshop, rehearsal, performance or other activity. I also agree to waive, release and discharge New Jersey Ballet, its members, officers, directors, agents, volunteers, assistants, employees, guest artists and faculty members from any and all losses, damages, liability, claims, demands or causes of action of any kind that may arise out of my (or my child’s) participation in any classes, lessons, workshops, rehearsals, performances or other activities conducted by New Jersey Ballet. I further agree to indemnify and hold harmless New Jersey Ballet, its members, officers, directors, agents, volunteers, assistants, employees, guest artists and faculty members from any and all losses, damages, liability, claims, demands or causes of action of any kind, including reasonable attorneys’ fees, that may arise out of my (or my child’s) participation in any New Jersey Ballet class, lesson, workshop, rehearsal, performance or other activity. If I am signing this assumption of risk, liability waiver and indemnification on behalf of my child, I represent that I am authorized to do so and acknowledge that my child shall be bound by the assumption of risk, liability waiver and indemnification provisions contained herein. The assumption of risk, liability waiver and indemnification provisions contained herein shall also apply to my (or my child’s) heirs, successors and assigns.

Your Signature

Thank you for submitting!

Artistic Director: Maria Kowroski

Bergen PAC NUTCRACKER - Registration Form