13+ Recital Check Out Form

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Special Pick up Permission Slip without Parent Signature
* Required

Dancer Name: *

Parent Name: *

Parent Contact Number: *

Dancer Date of Birth: *

YYYY

Recital Show (please check all that apply) *

Silver

Teal

Purple

Required

I hereby give Classic Image Dance, its staff, faculty and the volunteers of the 2019 Recital permission to release my child at the end of the Recital without my signature. I understand it is my responsibility to pick up my child and hereby hold Classic Image Dance, its staff, faculty and volunteers of the 2019 Recital harmless from any liability therein during this pick up at Desert Vista High School l in Phoenix, AZ. *

Yes, I agree and understand.

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