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