Father-Daughter Dance Registration

Father-Daughter Dance Registration

REMINDER: If you register online, physical tickets can be picked up at the WRAC front desk prior to the dance or claimed upon arrival the night of the event.
Parent/Guardian's Name:

First NameLast Name
Phone:
Format: (000) 000-0000.
Email:
example@example.com
# of Girls Attending:
Photo Release: By signing this registration, I grant consent for my and my minor's photograph to be taken with participating in this event, to use and publish photographs in all forms of media including, but not limited to, newsletters, Facebook, and website use. I hereby waive any right I may have to review, inspect, edit, or approve such publication, and I release the WRAC from any claims I may have against it for use of such photographs.
Parent/Guardian Signature:
Date:

MonthDayYear
Date
Waiver Statement: I hereby release and absolve the Wray Rehabilitation & Activities Center, their employees, volunteers, and other participants involved in the event from liability and/or claims of damages arising from the injury received by the participants involved, whether due to remission of said parties, or other participants, or otherwise.
Parent/Guardian Signature:
Date:

MonthDayYear
Date
We are also looking for volunteers to donate sweet treats for the evening
Name & Phone & Type of Treat
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Admission (1 dad and 1 daughter)
Admission for one dad and daughter pair

$20.00 Quantity

Additional Daughter(s)

$5.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Father-Daughter Dance Registration

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