I/We hereby release, discharge and agree to save harmless the Eleventh ACAS Chinese Dance Summer Workshop, its legal representatives or assignees, and all persons acting under its permission or authority, from any liability whatsoever for any and all claims of any nature which may arise out of my/our child attendance at the Chinese Dance Summer Workshop to be held at the ACAS Activity Center, 29 Montvale Ave., Woburn, MA, from August 8, 2010 through August 14, 2010.
I/We give permission to the Workshop authorities to have my child transported to a hospital and treated by a physician.
Parent's Signature: ______________________________________________
Date: ________________________________________________________
Address: ______________________________________________________
_____________________________________________________________
e-mail: ________________________________________________________
Telephone: ( ______ ) ___________________________________________
Student's Name: ________________________________________________
To register for the Chinese Dance Summer Workshop, please complete the
Application Form
& Liability Release Form and mail with
tuition by June 25,
2010 to:
American Chinese Art Society
111 Truman Road, Newton, MA 02459-2640
Tel. (617) 332-5376