Online Registration
*required fields
RELEASE OF LIABILITY
PHOTO/VIDEO RELEASE
Registration Fee
I understand that  my  (my child’s ) participation is voluntary, and I agree that Coast City Ballet-Pacific Dance Center their past, present and future
officers, employees, contract teachers, agents, representatives, successors assigns, insurers  are not liable for any harm, bodily injury, or damage
that may occur.

I grant to Coast City Ballet-Pacific Dance Center, its agents, representatives or anyone authorized by CCB-PDC administration, the right to take
photographs, videos or other material resembling me (my child) in connection with the above-identified classes/event.
I further authorize Coast City Ballet-Pacific Dance Center, its assigns and transferees to copyright, use and publish said photographs, videos, or
other material resembling me (my child) in print and/or electronically.  I agree that Coast City Ballet-Pacific Dance Center may use such
photographs, videos,or other material resembling  me (my child) with or without my name and for any lawful purpose, including for example such
purposes as publicity, illustration, advertising, Web content, Social media, or other dance related purpose deemed appropriate by CCB-PDC
administrative staff without compensation to me (my child), family, and/or agent.

I hereby release Coast City Ballet-Pacific Dance Center and their past, present and future officers, employees, contract teachers, agents,
representatives, successors, assigns, and insurers from any and all liability, loss, damage, costs, claims and/or causes of  action, including but
not limited to all bodily injuries, damages or loss of property arising out of participation in classes or activities.      

I understand this waiver may be used in a legal action against the undersigned and/or representative filing claims on their behalf
    
By submitting this form I agree to follow Coast City Ballet~Pacific Dance Center Studio Policies.

Please make your payment via the Button below and then click the submit button to submit registration. Thank you
9596 Hamilton Ave - Huntington Beach, CA  92646
714-963-9771
admin@coastcityballet.com - pdc@coastcityballet.com