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Solo dancer posing with arm up and purple ribbon flowing behind
Classes Registring For:

This form is correct to the best of my knowledge and the person(s) named above may participate in all activities. If I/my emergency contact cannot be reached in the event of an emergency, I hereby authorize Mariposa Dance Company to secure proper treatment for me/my child. In addition, I have read, understand, and agree with Mariposa Dance Company's policies. I further agree and understand that although Mariposa Dance Company has made every effort to ensure the safety of all participants, Mariposa Dance Company shall not be liable for any injuries, or illness due to viruses such as but not limited to, measles, mumps, Covid-19, chicken Pox, Flu, Pandemic, Lice etc. that the above named may receive while participating in the session for which he/she has registered. I agree that I shall make no claim and bring no action, suit or proceeding for any and all damages, losses, liabilities or costs in any manner suffered or incurred as a result of my or my child participating in the activity for which he/she has registered, and I hereby release Mariposa Dance Company and it's officers, directors and administration, and the owner/occupier of any facility in which I/my child participates in from any and all damages, liabilities, or costs in this regard.

Thanks for registering!

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