Please make checks payable to Haley's Playground and mail them to Haley's Playground c/o Stephanie's Academy of Dance 2230 Cornell Ave. Montgomery, IL 60538


Stephanie's Special Needs Therapeutic  Dance Camp

Waiver and Release of Claims and Assumption of Risk


Haley's Playground Inc. and Stephanie's Academy of Dance

Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity (including transportation services, when provided).

I recognize and acknowledge that there are certain risks of physical injury to participants in this program, and I voluntarily agree to assume the full risk of any injuries, damages or loss, including eye glasses and contact lenses, regardless of severity that my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with this program/activity. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against Haley’s Playground Inc. and Stephanie's Academy of Dance including its officials, agents, volunteers and employees.

I do hereby fully release and forever discharge Haley’s Playground Inc. and Stephanie's Academy of Dance from any and all claims for injuries, damages or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with this program/activity.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims.

**PARTICIPATION WILL BE DENIED-If the signature of adult participant or parent /guardian and date are not on this waiver.**