Birthday Party Waiver

Child Name *

First Name

Last Name

Parent/Carer Name *

First Name

Last Name

Emergency Contact Number *

(###)

###

####

Any Allergies or Medical Conditions? *

Yes

No

West End Dance may use images and videos from the party that include your child for promotional purposes. Please advise if you give permission for your child's image to be used by West End Dance. *

Yes

No

Your child will be included in a group photo with the party that will be shared with the party participants. Please advise if you give consent for child to be included in this image that will be shared with the other families of the party. *

Yes

No

I understand and accept the risk involved for my child to participate in dance and birthday party activities at West End Dance and give permission for my child to participate in all physical activities. *

Please note - Cirque themed parties will include aerial apparatus activities.

Yes

No