Mariposa Dance Company Dancers
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Register Online

Please complete this form to register for the 2017/2018 season.
Name *
Age / Date of Birth
Address
Town
Postal Code
Parent's Name
Home Phone
Work Phone
Cell Phone
Emergency Contact
Classes
Email Address *
I agree (read below) *

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 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 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.