All Level Line Dance Workshop & Dance

October 24, 2026

Bourne United Methodist Church, Crain Hall, 37 Sandwich Rd., Bourne MA

Participant First name

Participant Last name

Parent/Guardian Name if Participant is under 18

First & Last Name of Parent/Guardian (if not applicable, then enter N/A)

Phone

Address

CIty

State

Zip

What are you registering for?

$25 - Workshop and Dance - in advance

$30 - Workshop and Dance -at the door

$20 - Workshop Only - in advance

$25 - Workshop Only - at the door

$10 - Dance Only

EMERGENCY CONTACT

Emergency Contact - First & Last Name

Emergency Contact Phone Number

WAIVER, RELEASE OF LIABILITY, AND PHOTO/VIDEO RELEASE FORM

1. Assumption of Risk and Waiver of Liability

I acknowledge that line dancing involves physical activity with inherent risks, such as slips, falls, and muscle strains.
I knowingly assume all risks related to participation.
I, along with my representatives, release [Paula Frohn, Terry Hensel, Joanne & Demetrios Kallipolites, JMK Line Dancing] (the "Organizers") from liability for injuries, damages, or death during the activities.

2. Photography and Video Release

I grant the Organizer irrevocable permission to use photographs and videos of me from the activities for promotional, social media, and marketing purposes.
I waive rights to inspect, approve, or receive compensation for the use of my likeness.

3. Participant Acknowledgement and Signature

I confirm I am over 18 (or the parent/guardian) and have read and understood this release. I understand that by registering for this event, completing all required questions(as indicated by an*) and submitting the form by clicking on the "Register" button, that I agree to this Waiver, Release of Liability, and Photo/Video Release.

You may request 1 dance during this registration process. Please provide Dance Name, Choreographer & Song (if different than indicated on the stepsheet).

All Level Line Dance Workshop & Dance

EMERGENCY CONTACT

WAIVER, RELEASE OF LIABILITY, AND PHOTO/VIDEO RELEASE FORM

JMK Line Dancing