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Shruti’s Dance & Yoga

Shruti’s School of Performing Arts

1809 Airport Freeway Bedford Texas 76021

+14699781433
shrutisdanceyoga@gmail.com

Summer Camp – June/July | 2025

Membership and Waiver/Liability Release Form

Camp Session*

June

July

Both

Personal Details

First Name*

Your First Name

Last Name*

Your Last Name

Email Address*

Your Email Address

Phone Number*

Your Phone Number

Address*

Your Address

Age*

Your Current Age

Gender*

Write here

Any allergies or conditions we need to be aware of in order to better accommodate our participants?*

Yes

Write here

Emergency Contact Information

Full Name*

Emergency Contact Name

Contact Number*

Emergency Contact Number

Terms & Conditions

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared during the selected camp. In exchange for the acceptance of said child’s candidacy, I assume all risks and hazards incidental to the conduct of the activities and release Shruti’s Dance & Yoga of any liabilities. I also consent to creating and publishing educational, demonstrative and promotional videos, documents and photographs on the studio’s official website and social media platforms.

Medical Release and Authorization

As parent and/or Guardian of the named participant, i hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life.

I have read the above release and waiver of liability and understand its contents.*

I agree to the terms and conditions stated above.

Full Name*

Full Name

Date*

Select Date ×

Guardian Full Name*

Guardian Full Name

Signature

Payment Details

Total Amount

Payment Method*

Zelle

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shrutisdanceyoga@gmail.com

Registered as Shruti's SOPA LLC.

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Zelle Confirmation Code*

#123456789

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