Middle Tennessee Youth Ballet
Summer Intensive 2018
BIRTHDAY:
NAME:
AGE:
PARENT'S NAME:
ADDRESS:
PHONE:
E-MAIL:
PLEASE ENROLL MY CHILD IN THE 2018 MTYB     
SUMMER INTENSIVE.
ANY MEDICAL CONDITIONS OR ALLERGIES:
PLEASE SELECT
INTENSIVE LEVEL.
I, parent or legal guardian, hereby waive and hold harmless any and all Dance South AND Middle Tennessee
Youth Ballet staff and any other staff working in conjunction with Dance South AND Middle Tennessee Youth
Ballet and any and all facilities Dance South AND Middle Tennessee Youth Ballet deems necessary to use or
teach from or be associated with, whether paid or volunteer, for any injuries, claims or damages in conjunction
with Dance South AND Middle Tennessee Youth Ballet. I understand that as with any athletic activity that
involves motion, participation creates the possibility of accidental injury.  However, I also understand that
precautions will be taken to prevent such injuries.  I understand the risks involved in my child’s/ward’s
participation at Dance South AND Middle Tennessee Youth Ballet. I understand that Dance South AND Middle
Tennessee Youth Ballet do not offer any type of refunds.  I hereby consent and wish to have my child/ward
actively participate at Dance South.
Please check that you have read, understand,
and agree to the above terms and conditions.
Thank you for enrolling your child in the MTYB SUMMER DANCE INTENSIVE 2018.  We will
contact you within 5 business days to confirm enrollment.  

Please mail your payment to
MTYB Summer Intensive
137 Edenway Drive
White House, TN 37188
Or drop by our office Tuesday - Thursday 3:30 - 7:30.