Girl Scout Consent Form Girl Scout Badge Camp Participation Form Parent or Guardian Name(Required) First Last Participants Name(Required) First Last Troop Leaders Name First Last Date of Party Attending(Required) MM slash DD slash YYYY Parents Cell Phone(Required)Parents Email(Required) Parents Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent(Required) I agree to the liability release waiver.In consideration of receiving dance instruction including special classes in tumbling, hip hop, lyrical, etc....and other good and valuable consideration, hereby release and forever discharge the said Betty Johnson School of Dance, Inc DBA Bender Performing Arts (Betty Johnson Neal, Kevin and Meri Bender and all other instructors) their assistants, agents, servants and/or employees and their families, of any and all claims for damage, including injury and illness, or damages of any kind, nature or description; more particularly which may grow out of receiving dance instruction or participation in dance classes or other physical exercise or movement. I also release and hold harmless Betty Johnson School of Dance Inc. DBA and all others when participating in virtual classes and by participating; affirm that I have proper physical space, and my dancer(s) have appropriate physical health to participate. You must further release Betty Johnson School of Dance, Inc. DBA Bender Performing Arts (Betty Johnson Neal, Kevin and Meri Bender and all instructors) from any and all demands, claims, causes of action, suits, or liabilities whatsoever, of every name and nature, both in law and in equity; more especially on account of participation in classes taken at Betty Johnson School of Dance, Inc. DBA Bender Performing Arts.EmailThis field is for validation purposes and should be left unchanged. Register & View Classes Register TodayView Classes Quick Links Explore Classes by Grade Register Online Recital Info Upcoming Events Studio Rentals Find our dance studio Address: 3141 East Beardsley Road, Suite #110Phoenix, Arizona 85050 Phone: (602) 971-9170 Email: info@BenderPerformingArts.com
