Royal Palm DanceSport Championships – National Qualifying Event (NQE)

All Competitors: Please complete all information marked "(required)" for the Gentleman/ Leader and Lady/ Follower below.

Teachers with multiple Students: Please enter yourself and one Student as Gent/Leader and Lady/ Follower, and enter the info for your additional Students in the Box marked for you further below.

Parents/ Guardians of Minor Competitors: Please enter the name of each Competitor under Age 19 and the full Name & Contact Info for the Parent/ Guardian of such child in the Box marked for Parents/ Guardians further below.

Accept the Terms & Release by all Competitors and Parents/ Guardians named in this Form, and then click the red "Send" button at the bottom to submit this Form.

Gentleman/ Leader:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):

Gentleman/ Leader's USA Dance (or Affiliated Organization) Membership Number & Expiration Date
(Not required of Pros in Pro/Am Couples)

USA Dance Chapter of which Gentleman/ Leader is a member (if applicable):

Lady/ Follower:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):

Lady/ Follower's USA Dance (or Affiliated Organization) Membership Number & Expiration Date
(Not required of Pros in Pro/Am Couples)

USA Dance Chapter of which Lady/ Follower is a member (if applicable):

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Type of Couple: (required)
 Amateur Couple Same Sex Couple Pro/Am or Teacher/Student Couple Professional Couple

If you checked "Pro/Am or Teacher/ Student Couple" above, please enter the name of the Teacher:

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For Teachers Entering with More than One Student (required):
Enter below the Names and full Contact Information (and all information called for above) for each other Student you will dance with in the Royal Palm Dancesport Competition. INDICATE FOR EACH STUDENT WHETHER HE/SHE IS YOUNGER THAN 19:

Parents/ Guardians: Enter the Name of Each Above Competitor Younger than 19, and the Parent or Guardian's Information below (required):
Enter below the Name of each Competitor listed above who is Younger than 19, and the full Name, Telephone number, E-mail, and Address of the Parent or Guardian of such Competitor under age 19. If no Parent/Guardian information is entered below, you all represent and warrant that none of the Competitors listed anywhere in this Form is under Age 19 :

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Terms & Release Form (required of all Competitors and a Parent or Guardian for each Competitor under Age 19):
Please read and be sure the box is checked to Accept the following Terms & Release Form by each Competitor & each Parent or Guardian identified above, and then Click the red "SEND" button below to submit this Form.

- The Box Must be Checked to Accept the Terms & Release (required). By submitting this Competitor Information & Release Form and/or by registering for the Royal Palm Dancesport Competition, each Competitor and each Parent or Guardian identified above hereby represents, warrants, and agrees as follows:

1. Payment of Competitor Entry Fees Due. I agree that upon completing the Entries portion of the online Competitor Registration form on O2cm, I/ we will complete Steps 5 and 6 of the O2cm form to add the applicable Competitor Package due for each dancer in our couple, and immediately use the "Pay Now" button found at the bottom of the O2cm Registration Form to pay in full the Competitor Package fees and any Entry Fees applicable for our entries via PayPal or Credit Card. I/ we understand that our Registration is not complete until the Competition Organizer receives full payment of our Competitor Package fees & Entry Fees, as well as the Registration Form for each couple.

2. Waiver, Release & Indemnity Accepted and Agreed: I have read, understand and agree to abide by the USA Dance DanceSport Rulebook, as and to the extent applied at the Royal Palm Dancesport Competition (the "Competition"), and the Rules, Regulations and Guidelines for this Competition, as set forth on www.RoyalPalmDancesport.org. As a Competitor, I represent and warrant that I am eligible to enter all events for which my partner and I register and that we will not register for an event below our minimum proficiency level in each category or above our maximum Age Category. I understand that athletes may be subject to drug testing by the WDSF or USA Dance, and if I am an Amateur Athlete Member of USA Dance, I understand that if I violate the Dancesport Rules of USA Dance, as applied at this Competition, my Amateur Athlete competitor status with USA Dance may be suspended. I understand the Competition may be filmed/videoed/photographed and I agree that the organizers may use my name and/or any images or videos captured of me at the Competition for promotional or other purposes related to the Competition, now or in the future. I consent to receiving e-mails or communications from the organizers, now or in the future (from which I may unsubscribe after the Competition, if I so choose). I understand and agree that no responsibility for bodily injury or for loss or theft of articles left in the changing rooms, Competition venue, practice room, seating areas or elsewhere by persons attending or participating in this event, can or will be accepted by the organizers, USA Dance, Inc., the Royal Palm Chapter of USA Dance, Goldcoast Ballroom, any of their respective officers, directors, agents or representatives, or any hotel (the "Releasees"). I further understand and agree that the Releasees shall not be responsible for any airfare, hotel, or other travel expenses, fees or penalties incurred by any Competitor or spectator for any reason, whether due to cancellation by such person, cancellation of the Competition for any reason, or any other cause. I hereby waive, release, hold harmless, and agree to indemnify all of the foregoing Releasees from and against, any and all claims or liabilities of any kind arising in connection with my/ our registration for, participation in, attendance at, or travel to or from or while at, the Competition, or any cancellation of the Competition by the organizers. I understand and agree that everyone attending the Competition does so at his or her own risk. Each Parent or Guardian of a Competitor under Age 19 identified in the Form above, hereby consents to his/her child's participation in the Competition, and, for himself/ herself and such minors, hereby agrees to all of the above Terms, and agrees to and grants all of the representations, warranties, waivers, releases, and indemnities stated above.

Please be sure you have filled in all blanks and check boxes above marked "(required)" and pertinent to you, and that the box is checked to accept the Terms & Release,
or this Form will not submit.

To Submit Your Competitor Information & Release Form and Register for the Competition:

Step 1:   Click the Red "SEND" button below to Submit this Form. You should then see a message outlined in green on your screen below, saying, "Your Competitor Information & Release Form was submitted successfully."

Step 2:   Watch your E-mail. You will receive an e-mail with instructions and a link to our O2cm online Registration Form, where you can Register for the Competition and pay your Competitor Package and Entry Fees. Your Registration will not be complete until we receive both your Registration Form and payment in full, for each couple. (If you have already registered for the Competition, you can ignore the e-mail you will receive.)