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Dance For Parkinson's Registration Form
Which classes do you plan on attending?
I plan on attending class on Wednesdays from 11:30am-1:00pm
I plan on attending class on Wednesdays from 1:30pm-3:00pm
Do you plan on attending the classes by yourself or with a caregiver, spouse, or partner?
I am attending by myself
I am attending with another person
Is there anything else you'd like to tell us?
As a condition of my participation in Dance for Parkinson's (the “Program”) by Ruth Davidson Hahn & Company (RDH Dance) and Rhea Gill and Pure Movement Dance Institute L.L.C. (PMDI), I agree that:
1. I am physically able to participate in the Program, and have not been advised otherwise by a medical professional.
2. I agree to comply with any and all instructions, information, and rules, for participation in the Program.
3. I acknowledge that the Program may involve risk of physical injury and I accept those risks, and assume all responsibility for my participation and waive any claims against RDH Dance and PMDI for any and all injuries arising out of my participation in the Program, and further agree to indemnify, defend and hold the RDH Dance and PMDI harmless from and against any and all claims for damages, injuries, losses, liabilities and expenses relating to, resulting from and arising out of my participation in the Program.
4. I intend that this waiver of liability against RDH Dance and PMDI shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law; which shall be governed by and construed under the laws of the State of Nebraska. If any part of this document is found unenforceable, all other parts shall be fully enforceable.
5. The participation payment is a single payment for the entire Program paid at the first class of the current series, though single session payment is accepted. We will charge you a $15.00 fee for returned checks or credit cards due to insufficient funds.
I have read the above and agree
Enter your full name
DANCE FOR PD is a Registered Service Mark of
Mark Morris Dance Group and Brooklyn Parkinson Group
Dance for Parkinson’s
Presented in Lincoln By:
2100 Fletcher Ave Lincoln, NE 68521