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Name *
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Siblings at The Dance Studio (Names & Ages)
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	I/we, on behalf of myself/ourselves and my/our minor child hereby release The Dance Studio, Inc., it’s officers, agents and employees and Northwestern College, from all claims for injury which may be sustained by my/our child while participating in dance classes, rehearsals, performances or other dance related activities.
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The Dance Studio

PO BOX 49578

Blaine, MN 55449

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