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2. Father Daughter Dance 2017
   Please contact the RecPlex Staff at 417-335-2368 after submitting this form for payment options.
4. Father's Name:*
5. Date of Birth*
   Date of Birth
7. Daughter 1:*
8. Date of Birth*
   Date of Birth
10. Daughter 2:
11. Date of Birth
    Date of Birth
13. Daughter 3:
14. Date of Birth
    Date of Birth
16. Total Number Attending*
17. Session:*

    1. 2:00-4:00PM
    2. 6:30-8:30PM
19. Home/Cell Phone Number*
20. Work Phone Number
22. Address1*
24. Address2
26. City*
27. State*
28. Zip*
30. Email Address*
32. Waiver*

    I hereby waive, release, and forever discharge all claims against the City of Branson, its employees, volunteers, commissioners or agents for damages and/or injuries, which may arise from participation in the above named program. I hereby authorize any duly licensed physician, Emergency Medical Technician or medical facility to treat the above named person for injuries that may be received while participating in the program. I acknowledge that no warranty is being made as to the result of such treatment.

    1. Agree
34. Please contact the RecPlex Staff at 417-335-2368 after submitting this form for payment options.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field