High Sierra Swing Dance Club

a non-profit organization

 

High Sierra Swing Dance Club

PO Box 2446

Carson City, NV 89702-2446

 

Select all to print this page or click on highlighted membership for a pdf form to print

If you have any questions please Email - Idie Zaman

 

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

Effect: 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