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PROGRAM LIABILITY RELEASE WAIVER

Please read and fill out the form below.

PROGRAM LIABILITY RELEASE WAIVER

Online

Program Name

Gym Owner/Director

Date

Your Signature

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LIABILITY RELEASE WAIVER
RE: COPYRIGHT MUSIC

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Liability Release Waiver

RE: Copyright Music

Online

Event

Event Date

Organization

Address

Phone No

Representative Name

Representative Title

Acknowledged Signature / Date

MCDA Staff Signature / Date

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contact

LOCATION

PO Box 50 | Bethalto, IL 62010

PHONE

Kim 618-530-7948

Kristi 629-333-6398

EMAIL

kim@midwestcheeranddance.com

kristi@midwestcheeranddance.com

DUNS

051300461

CAGE CODE

8P0X3

Quick Registration

Forms & Waivers

MCDA Medical Release Form