Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Participant's Name *FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you completing this form for a minor? *YesNoPlease list all your children that are attending Christmas Country Dance School. <br />Include their first and last names. *Email * of are Address In consideration of my participation (or that of my minor child), in the activities of the Christmas Country Dance School (the “School”) on the Berea College campus, I represent and agree as follows: I understand that there are certain risks inherent or incident to participation in the School, use of College facilities and premises, consumption of food and lodging, dancing and related physical activities, weather and natural hazards of all kinds. I (and any minor child of mine participating in the School) have no medical or other conditions that would preclude participation in the School. I agree that all times during the School, I am responsible for my own conduct and personal safety (as well as that of any minor child of mine at the School). In consideration of participation in the School and use of the premises of Berea College, I for myself, (as well as any minor child of mine at the School), any and all heirs, successors and assigns, hereby release and hold harmless Berea Christmas Country Dance School, Inc. and Berea College, its trustees, officers, faculty, staff, agents, employees, students and representatives, from any and all claims, demands, causes of action or damages which may accrue on account of my participation or that of my minor children at the School. I am aware of the risks inherent or incident to the School, including but not limited to the risks described above, and I, for myself (including any minor child of mine at the School) hereby assume any and all risks attendant to participation in the School. I (and any minor child of mine at the School) agree to observe the expectations and rules of the School that are announced during the School or published online at http://www.bereaccds.org. Signature of Participant * Clear Signature Parent or Guardian's Name *FirstLastSignature of Parent or Guardian * Clear Signature Parent or Guardian's Phone Number *Submit