Saturday, November 22, 2008

Name: ____________________________________________________

Street: ____________________________________________________

City and zip: _______________________________________________

Phone #: __________________  e-mail:__________________________
 

Registrants must be at least 14 years old to participate in the workshops. Please complete one form for each workshop participant.

November 22 :          Props Choreography Workshop
                                                                                                 $35

Total amount enclosed:                                                                                                                                    _______

Please read carefully before signing:
Participation in any Blue Moon Dance Company activity and use of any recreational facilities involves a risk of accidental injury despite all safety precautions. I/we, as an individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and agreed to indemnify and hold harmless Blue Moon Dance Company for any illness or injury to me or my child occurring during my participation in any activity conducted by Blue Moon Dance Company.

Sign below only after carefully reading the above.

Signature ________________________________ Date _______________
Note: Signature is required as a condition of registration.

No refunds given unless event is cancelled; registrations are transferrable to another person. Please notify Blue Moon if this occurs. 

Please print this form and mail it along with your check payable to:

Blue Moon Dance Company  104 Southwold Drive  Cary, NC  27519