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High
Sierra Swing Dance Club
a non-profit organization
High Sierra Swing Dance Club
PO Box 2446
Carson City, NV 89702-2446
Please fill out the form completely, so that we can update our Computer files with accurate information. Membership dues are $25 for Singles & $40 for partners per year (Partners are defined as one Leader & one Follower)
Right-click this page, select Print from the drop-down menu, print and mail to the above address with check for your dues.
O new member O renewal O new address O new phone
First Member: ___________________________________________________
Mail Address: ___________________________________________________
Telephone: __________________________________________________
E-Mail Address: _________________________________________________
Birthday: Month ______ Day:
_____ Member # __________
Second Member: ____________________________________________
Mail Address: __________________________________________________
Telephone:
___________________________________________________
E-Mail Address: ________________________________________________
Birthday: Month ______ Day:
_____ Member # __________
O I would be interested in serving on a committee
O I would be interested in being on the Board of Directors
Disclaimers and Waivers:
Unconditional Waiver:
I, (parent/guardian) on behalf of myself, my spouse, my
parents and my children, agree that in the event I, or my
child/ward, should sustain personal injury or property
damage as a result of participation in HSSDC activities,
that the HSSDC, Instructor, the Owner of the facilities,
their employees and assistants will not be liable for such
injury or damage.
Assumption of the Risk:
I understand that it is my responsibility to inquire about
the parameters of the HSSDC activities and to assess the
ability of myself and my child/ward to safely participate in
the program. I further understand that certain activities
are potentially dangerous, and I assume, on behalf of myself
and my child/ward, all risks associated with participation
in all HSSDC activities, and waive any right to hold HSSDC,
it’s representatives
Effect: I understand that this Waiver and Release is
binding as to my family members, heirs and executors.
Medical Emergency: In case of medical emergency, accident
or illness, the HSSDC and assistants has my permission to
secure medical attention as deemed necessary.
I acknowledge the above waiver and agree to all terms.
Signed: _______________________ Date:
________ Signed: _______________________ Date:
________
First
Member
Second Member