Dance Unto  the Lord, Inc.
9907 N. Oklawaha Ave. Tampa, FL 33617
P. (813) 503-6863 E. dutlconference@yahoo.com
Web site: www.geocities.com/dutlconference

DANCE CONFERENCE LIABILITY WAIVER 2006

All waivers must be completed before entering conference workshop classes!

I, ____________________________________ do hereby acknowledge that I intend to participate in the 
4th Annual Dance Ministry Conference 2006 – Dance Unto the Lord. I also acknowledge that I will be doing 
so of my own free will.

I, _____________________________________ as parent of the above, acknowledge my child’s desire to participate 
in the 4th Annual Dance Ministry Conference 2006 – Dance Unto the Lord.

We acknowledge that the Dance Unto the Lord, Inc. – 2006 Dance Ministry Conference teachers and staff will behave 
prudently in the safety of dance classes in order to avoid accidents and/or injuries from occurring.  We realize that participation in vigorous activities entail the risk of injury to the participants.  We accept 
this risk regardless of the nature of the injury.

We also waive and absolve Dance Unto the Lord, Inc. and the founder, teachers, advisors, sponsors, volunteers and the 
staff from any and all liability and responsibility for injuries, sickness, accidents, and/or natural occurrences during participation by myself / my child in the Dance Unto the Lord conference and/or any other Dance Unto the Lord, Inc. conference related activity.

We understand that each participant is responsible for his or her own personal health, medical, dental, chiropractic, 
and accident insurance coverage.

_________(Please Initial) We acknowledge that at this event pictures may be taken of participants, which may include 
my child/me. We authorize the 4th Annual Dance Ministry Conference 2006 – Dance Unto the Lord to use pictures of 
my child/me for promotional purposes only. We, intending to be legally bound, do hereby, my heirs, executor, and administration, waive, release, and forever discharge any and all rights and claims for damage which I may have or may hereafter accrue to me or my child against the 4th Annual Dance Ministry Conference 2006 – Dance Unto the Lord, the founder, teachers, advisors, sponsors, volunteers and the staff, for any damages which may be sustained or suffered by me or my child in connection with my association with or participation in, or rising out of travel to and/or return from any DANCE UNTO THE LORD related site or activity affiliated with 4th Annual Dance Ministry Conference 2006  – Dance Unto the Lord.

Dated this___________ Day of_______ 20___________ Home Phone: __________________________
Name of Participant_____________________________Signature__________________________________
Parent / Legal Guardian__________________________Signature__________________________________
Health Card #__________________________________Date of Birth________________________________

Please List 2 Emergency Contact Names and Numbers:

1.  (Name)____________________________________________(Phone #)______________________________
2.  (Name)____________________________________________(Phone #)______________________________