The Show Stoppaz - Application Form

My child’s image can be used in video and/or photos for promotional, publicity, broadcast, and/or publications of this event: Yes or No.

In consideration of participation in The Show Stoppaz Tryouts Event, I hereby waive and release any and all claims of damages for any and all injuries suffered to my minor child, named in this form under "Candidate's Name", against the event facility and The Show Stoppaz Dance Team.

*Parent/Guardian’s Signature

* I agree with the terms of the waiver/release

Personal Information (* Required Information)
*Candidate's Name
* Birth Date
* Age (As of Dec. 31, 2006)
* School Attending
* Grade
Parental Information
* Parent/Guardian Name
* Address, City, State, ZIP
* Home Phone
* Work Phone
Cell Phone
* Relationship to Candidate
* E-Mail Address
Extracurricular Activities
Other clubs, teams, organizations candidate plans to participate in ‘06-07:
Please list any information that you would like to share with the committee before tryouts.
My child’s image can be used in video and/or photos for promotional, publicity, broadcast, and/or publications of this event: Yes or No. In consideration of participation in The Show Stoppaz Tryouts Event, I hereby waive and release any and all claims of damages for any and all injuries suffered to my minor child, named in this form under "Candidate's Name", against the event facility and The Show Stoppaz Dance Team. Parent/Guardian’s Signature I agree with the terms of the waiver/release