High Sierra Swing Dance Club
a non-profit organization

High Sierra Swing Dance Club
PO Box  2446
Carson City, NV 89702-2446

If you have any questions please Email - Rika Rich

Please fill out the form completely, so that we can update our Computer files with accurate information. Membership dues are $25 for Singles & $40 for partners per year (Partners are defined as one Leader & one Follower)

Right-click this page, select Print from the drop-down menu, print and mail to the above address with check  for your dues.

O  new member  O renewal   O new address  O new phone

First Member:  ___________________________________________________

Mail Address:  ___________________________________________________
City & State __________________________________________________, Zip ____________
Telephone:      __________________________________________________

E-Mail Address: _________________________________________________
Birthday: Month ______  Day: _____                     Member # __________

Second Member: ____________________________________________

Mail Address: __________________________________________________
City & State __________________________________________________, Zip ____________
Telephone:  ___________________________________________________

E-Mail Address: ________________________________________________
Birthday: Month ______  Day: _____                    Member # __________

O  I would be interested in serving on a committee
O  I would be interested in being on the Board of Directors

Disclaimers and Waivers:
Unconditional Waiver:
  I, (parent/guardian) on behalf of myself, my spouse, my parents and my children, agree that in the event I, or my child/ward, should sustain personal injury or property damage as a result of participation in HSSDC activities, that the HSSDC, Instructor, the Owner of the facilities, their employees and assistants will not be liable for such injury or damage.
Assumption of the Risk:
 I understand that it is my responsibility to inquire about the parameters of the HSSDC activities and to assess the ability of myself and my child/ward to safely participate in the program.  I further understand that certain activities are potentially dangerous, and I assume, on behalf of myself and my child/ward, all risks associated with participation in all HSSDC activities, and waive any right  to hold HSSDC, it’s representatives
  I understand that this Waiver and Release is binding as to my family members, heirs and executors.
Medical Emergency:
  In case of medical emergency, accident or illness, the HSSDC and assistants has my permission to secure medical attention as deemed necessary. 

I acknowledge the above waiver and agree to all terms.

Signed: _______________________     Date: ________      Signed: _______________________  Date: ________
                            First Member                                                                                         Second Member

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