Waiver | Ballroom Dance Preservation Society

WAIVER FORM

Please read Waiver Form Agreement and check box (I Agree), then fill in your name, e-mail address and answer all questions. When completed, put your full name in the signature box and click the submit button. This will send the form to us.

I understand and agree to these conditions for participation in Ballroom Dance Preservation Society (BDPS) : Dance is a physical activity that includes close physical contact with other participants. Like all physical activities, dance carries some degree of risk. By clicking I agree below, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending the dance or classes, you voluntarily assume all risks related to exposure to COVID-19 and agree not to hold BDPS, its officers or volunteers liable for any illness or injury or for any loss, damage, or theft of articles from event facilities during events. I hereby give my permission to the Ballroom Dance Preservation Society (BDPS) to use my photos on the website, in advertising, and/or emails to further promote the BDPS and its mission. *

I Agree

Name *

First

Last

Have you received the COVID-19 Vaccine?

If Yes, Please mark off the Vaccine you received

First Dose (Pfizer or Moderna)
Second Dose (Pfizer or Moderna)
Johnson & Johnson

Signature *

Printing your name above acts as your signature

Name