Permission Slip for Minors (anyone under 18)
As with any activity requiring physical participation, there is a risk of physical injury
while dancing. By signing this permission slip, you, the parent/legal guardian
acknowledges that you are accepting all responsibility/liability for your minor child.  
You also acknowledge that you  have the legal right to sign this slip.  Neither
Organic Rhythms Dance Studio nor its owners/instructors are responsible for any

Please complete a slip for each child participating in any classes given by Organic
Rhythms Dance Studio.

Parents/Legal Guardians, please bring your valid driver's license, state ID, or
passport.  Thank you.
Class the Minor child will be taking:_____________________________________

Name of minor:_____________________________________________________

Age:______  Date of Birth:_____________

Allergies/Special Needs:_______________________________________________


Contact Number(s):_____________________________________________

Name of Parent/Legal Guardian (print):__________________________________

Signature of Parent/Legal Guardian:_____________________________________

Driver's License/State/Passport ID#_____________________________________
License/ID/Passport Exp. Date:_______________________

Today's Date:______________