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  • Kids Clinic Registration Form

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    dhsdiamonds
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    Child agrees to indemnify and hold harmless the Diamonds or the Dickinson, its staff, director, and Dickinson High School. In the event of an emergency, I give permission for Dickinson and / or the Diamonds to give my child simple first aid and to arrange for transportation to a hospital and receive emergency medical treatment.

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    Child agrees to indemnify and hold harmless the Diamonds or the Dickinson, its staff, director, and Dickinson High School. In the event of an emergency, I give permission for Dickinson and / or the Diamonds to give my child simple first aid and to arrange for transportation to a hospital and receive emergency medical treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    95 views1 page

    Kids Clinic Registration Form

    Uploaded by

    dhsdiamonds
    Child agrees to indemnify and hold harmless the Diamonds or the Dickinson, its staff, director, and Dickinson High School. In the event of an emergency, I give permission for Dickinson and / or the Diamonds to give my child simple first aid and to arrange for transportation to a hospital and receive emergency medical treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    StudentsName Address BirthDate PhoneNumber

    CellPhone

    _________

    CurrentAge

    Grade

    Whotocontactincaseofemergency? Name Phone Relationshiptostudent?

    IgivetheabovenamedpermissiontoparticipateinaDanceClinichostedbytheDickinsonDiamonds.Also,theabovenamedchild(his/herlegal guardianorparentifundereighteenyearsofage)agreestoindemnifyandholdharmlesstheDiamondsortheDickinson,itsstaff,director,and DickinsonHighSchool,fromandagainstanyandallliability,claims,suits,damages,lossesandexpenses,includingattorneyfees,threatenedor incurred,andarisingfromthechildsparticipationinthisdanceclinic,orbyreasonofanyinjuryoranydamagetosaidchildortoanypersonor propertyoccurringduringsaidparticipation,orfromanycausewhatsoever.Inaneventofanemergency,IgivepermissionforDickinsonHigh Schooland/ortheDiamondstogivemychildsimplefirstaidandtoarrangefortransportationtoahospitalandreceiveemergencymedicaltreatment. Iwillassumeallcostsformedicalcare.Signingthisformmeansyouagreewiththispolicy.

    ParentorGuardianSignature

    Date

    Completetheregistrationformandsubmitwithpaymentof$25to: DiamondsDanceTeamDickinsonHighSchool 3800BakerDrive Dickinson TX 77539

    Students will perform at the Diamonds Spring Show on Thursday, April 19th 2012 Your Diamonds Name: __________________________________

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