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Student's Name and Age

Dance?, Gymnastics?, Aerial, or a Combination of?

Parent's Name, Phone Number, and Email

Best Days and Times for Class

REQUIRED RELEASE: I agree to all of studio policies and agreements on this form and on the website. The undersigned parent or guardian of (“Minor”) hereby consents to the minor participating in Dubuque Dance Studio and Gymnastics Club classes, events, activities, programs and other (“activities”). The undersigned, for himself or herself, and on behalf of said Minor, and anyone claiming through the undersigned or the Minor, does hereby absolutely and unconditionally release, indemnify, hold harmless and forever discharge: DFDMH Enterprises, L.L.C. and AAADDH Ltd., its officers, directors, officials, volunteers, agents, employees, its successors or assigns, Deanne M. Hohmann, individually; David F. Hohmann, individually; and Alicia C. Hohmann, individually; (hereinafter “Released Parties”) from any and all claims, demands, obligations and liabilities of every nature and kind whatsoever, including, but not limited to, and without limitation, negligence, occurring during, directly or indirectly, resulting from or arising out of the Minor’s participation in the activities. As to matters covered by hereby, the consent and release shall extinguish all claims, demands and rights which the undersigned or the Minor (and/or each of their heirs, successors and assigns) has or may ever have against the parties released hereby, or any of them, for any injuries, bodily injuries, loss of life, property damage, loss or personal loss, costs or damages to the Minor occurring directly or indirectly, resulting from or arising out of the Minor’s participation in activities, whether such injuries, bodily injuries, loss of life, property damage, loss or personal loss, costs or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable. Further, the Released Parties are released from any and all claims based upon the acts, omissions, or negligence of Released Parties. As a precedent to participating in the activities, the undersigned, individually and on behalf of the named Minor, knowingly and voluntarily assumes any and all risk inherent in the participation and agrees to abide by all rules and regulations established by Released Parties. My information is correct. I have read or informed Custodians of studio policies and agreements on the back of this form, I ensure that, I/We have read and agree to all studio policies: Sign Full Name