CONTACT​ US

5611 East Morgan Avenue, Suite A

Evansville, IN 47715

Tel: 812-602-5400

email: info@thrive5678.com

 

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    created by Thrive Dance Cheer Tumble LLC 7/2016

     

    Participants

    Name: _____________________________________________________     Age: ____________________

     

    Parent Name: __________________________________________________________________________

     

    Address: ________________________________________________________________________________

     

    Phone: ______________________________________  Email: __________________________________

     

    Event/

    Activity: ________________________________________________________________________________

     

    How did you hear about THR!VE? ____________________________________________________

     

    Method of Payment: Cash______ Check ______ Credit Card _______ No Charge _______

     

    Participant Emergency Contact Number: ____________________________________________

     

    Liability Release: I understand that my participation in any THR!VE LLC (Dance, Cheer, Tumble, Camp, Workshop, Birthday Party) activity, may result in injury.  I acknowledge and understand that injuries are common among dance, cheer & tumble related events and that I am assuming the risk of such injury by participating in any activities at THR!VE LLC.  In the event of injury, I authorize THR!VE LLC Staff to obtain necessary medical treatment on my behalf.  I understand that THR!VE LLC, the host studio and/or it’s directors, officers, owners, employees, teachers, assistants, staff, crew, etc. are not liable for personal illness, personal injury, damage or loss to personal property.  I understand that I will be responsible for any and all medical and related bills and claims that may be incurred for any illness or injury that I may sustain during a THR!VE LLC activity.  I also understand I may decline to participate in any class or any activity.

    Appearance Agreement:  I understand that as a participant in and/or a spectator at THR!VE LLC activity, I may be included in videotapes or photographs taken during the event.  I agree to be photographed and/or videotaped and that my name, face, likeness voice, and appearance may be used in advertising and promoting THR!VE LLC.

     

    Signature (minor participant):___________________________________________Date:_____________

    Parent or legal Guardian (print):____________________________________________________________

    Parent or legal Guardian signature: _____________________________________Date:_____________