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Name____________.          DOB__________

Parent/Guardian__________________. PH_________
I, the parent/guardian of aforementioned student, by signing below, agree in their participation in dance class sponsored by Dickinson Dance+. I understand any form of dance may at times require physical contact with the instructor  in order to make necessary corrections to body/limb alignment.
I also understand dance and other athletics may cause physical discomfort and make no claim to be brought against Dickinson Dance+ , it’s staff or WRCC.

_________________.               ______________

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