THON 2013 Dancer Registration Packet

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DANCER REGISTRATION PACKET 2013 Penn State IFC/Panhellenic Dance Marathon 14
DANCER REGISTRATION PACKET 2013 Penn State IFC/Panhellenic Dance Marathon Dancer Registration Form Dancer B Name: __________________________________ PSU ID #:________________ (Last) (First) (MI) Local Phone: ___________________________ Sex: Male Female Local Address: ___________________________ ___________________________ Email: ___________________________ Partners Name: ___________________________ List a local person that we can contact in case of an emergency (Someone in the State College area with access to a car): Name: _________________________ Phone: __________________ Address: _________________________ _________________________ Relation: _________________________ Email: _________________________ Parent Information for emergency contact Name: __________________________ Phone: _________________ Address: __________________________ __________________________ Email: __________________________ COUPLE # ___________ In consideration for the opportunity to participate in this event, which is co-sponsored by the Interfraternity and Panhellenic Councils and takes place on the premises of The Pennsylvania State University, I hereby release all parties and their employees and representatives from any and all liability for injuries or damages that I may sustain as a result of my participation in the Penn State IFC/Panhellenic Dance Marathon 2013. I also realize that any medical expenses incurred, as a result of my participation in this event, will be my sole responsibility. By my signature below, I hereby acknowledge that I am at least 18 years of age. Dancer B: ___________________________________ (Signature) 15
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THON 2013 Dancer Registration Packet

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