Date

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

How did you hear about Vitacca Dance Project?

(Please check all that apply)

Answers4Dancers.com

Facebook

Friend

Vitacca Dance Project Website

Twitter

Other website

Poster

*

In consideration for receiving permission to participate in this audition, or any and all activities related thereto, including but not limited to travel between sites or locations (“Activities”), I hereby release, indemnify, and covenant not to sue Kelly Ann Vitacca, Vitacca Productions and Company, and any officers, principals, agents, associates or employees thereof (“Releasees”), for any and all claims, costs and causes of action for property damage or personal injury, sustained by me while participating in Activities, whether arising from statute, code, ordinance, tort, common law or other source. I acknowledge that Activities I will perform may be physically strenuous. I know of no physical or mental condition which would preclude or inhibit my full participation in Activities. I am fully aware of the risks and hazards involved with Activities, and I choose to voluntarily participate.

I agree

Date *

MM

DD

YYYY