Name of Buddy Candidate *

First Name

Last Name

DOB *

MM

DD

YYYY

Name of Parent/Guardian *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Which classes would your child be available to assist at? *

Select all that apply

Thursdays 5:15-6:15pm (Campbell)

Fridays 5:00-6:00pm (Milpitas)

How often can your child commit to being a Buddy? *

1x/week

2x/week

1x/month

2x/month

When would your child be available to start? *

MM

DD

YYYY

Liability Waiver & Consent *

I, the parent or guardian, understand & agree that in participating in any dance class or other event there is a possibility of physical injury. I voluntarily agree, therefore, to assume all risks & responsibility for any such injury or accident which might occur to me/my child during any of the activities provided by MAGIC Dance Arts, Inc. I also exempt, release, & indemnify MAGIC Dance Arts, Inc. from any & all liability claims, demands, or causes of action whatsoever from any damage, loss, or injury to me, my child, or property which may arise out of or in connection with participation in any activities conducted by MAGIC. I understand that I should be aware of my/my child’s physical limitations & agree not to exceed them. By agreeing to the terms and conditions, I hereby consent to MAGIC Dance Arts Inc. using and publishing the information provided including my name, photograph, statement, video, and any other information I have given to MAGIC Dance Arts, Inc. I release MAGIC Dance Arts, Inc. from all liability and any claims I may have arising from the use and publication of this material.

I agree