Acknowledgement & Release

Lobby Supervision

Confirm supervision plans for your student before, between, and after classes.

Dancer's First Name

Dancer's Last Name

Studio Location

BaxterProvidence

Parent/Guardian Name

Parent/Guardian Email

By signing below, you confirm that you have read, understand, and agree to the following statements for the student named on this form.

Recognition of Unsupervised Status

Assumption of Risk

Release of Liability

Authority to Consent

Supervision Plan

My student can remain unsupervised and it is my responsibility to remind him/her that he/she cannot leave the building for any reason.I will pick up my student between breaks — and understand we cannot stay inside the building, but will return for their next class.My student has a signed dismissal waiver (for ages 11+) and allowed to leave the buildingMy student is currently under the age of 7 and I understand they are not to be left at the studio before, between or after classes and I must be there to pick them up immediately following their class

Acknowledgement Name

Parent/Guardian Signature

Lobby Supervision

Let's Find the Perfect Class

Thanks!

0 Directors

Acknowledgement Received