CONTACT INFORMATION :

First name (required)
 

Last name (required)
 

Email (required)
 

Dance city
 

HOUSING INFORMATION :

I am a :
GuestHost Neither

Allergens
 

Housemate requests :
 

Other :
 

WAIVER :

By accepting the waiver, you are stating that you understand and agree with the following items:

I understand that there are risks of injury associated with all forms of dancing and that I assume such risks and agree that the organizers and any associated instructors or staff will not be responsible for any injury that I incur in or as a result of the classes, dances, and/or any Revival Day event that I take part in.

I understand that there will be still cameras and video cameras capturing the event for recreational and promotional purposes. I hereby give permission to Revival Day to use any images or video of myself that is captured during the event in any future promotions or advertisements for dance events run by the organizers of Revival Day.  If any person does not wish to appear in pictures or video, I will respect their wishes and refrain from taking pictures of or video taping that person.  If pictures or video have already been taken and/or published, I will refrain from further publication of those images if asked to do so.

I understand that my registration is not complete until any monies due have been paid.  I understand that all registration submissions are final.  I understand that my registration may be denied at any time and for any reason, and that if my registration is denied, any money paid will be refunded.  I understand that refunds will not be given for reasons other than denial of my registration request.

By checking this box I hereby declare that I have read and agree to the waiver for attending Revival Day (required for admission)

(this will submit your application for processing)

(this will clear all of the data you have entered)