Partner's name (if you are registering with one): ___________________________ Class (Check all that apply): |
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The student/participant recognizes the risk of accident or injury inherent in an exercise or dance program and waives, releases, and holds harmless the Masonic Lodge (Porter Square) Steve Bailey, Sara Fajkowski, their heirs, assigns, instructors, employees and independent contractors from liability for injury, damages, or claims arising from participation in any program with Steve Bailey and Sara Fajkowski. Furthermore, the student/participant agrees to practice all steps with caution and in full awareness of both his/her partner and those around him/her. I have read the above information and agree to abide by its contents. Name:_____________________________
Date:____________ ________________________________ |
| Please print out this form and send
it along with payment to:
Steve Bailey |
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