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ASSUMPTION OF RISK • WAIVER AND RELEASE OF LIABILITY • PHOTO RELEASE • MEDICAL AUTHORIZATION/PAYMENT
ACKNOWLEDGEMENT of RISK: I recognize that due to the physical nature of activities in which Rock With Me and Dance engages, injuries can occur.
CONSENT and ASSUMPTION OF RISK: Being fully aware of these dangers, I hereby give consent for me or my child(ren) to participate in any and all Rock With Me and Dance programs and activities for which they are registered, and I ACCEPT ALL RISKS associated with this participation.
WAIVER and RELEASE: In consideration for me or my child(ren)’s participation I hereby, for myself and my child(ren) and our respective heirs and successors, PROMISE NOT TO SUE and FOREVER RELEASE AND DISCHARGE Rock With Me and Dance, its officers, directors, shareholders, employees, contractors, teachers, coaches and volunteers from all liability resulting from damages or injuries incurred as a result of participation in Rock With Me and Dance programs. I agree that I am responsible for the health and accident insurance and any medical costs for the above student incurred due to injury including, but not limited to, emergency medical transportation and treatment if the need arises.
PHOTO RELEASE: I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for me or my child(ren)’s participation I hereby grant permission for my child(ren)’s likeness to be used in Rock With Me and Dance publicity or advertising.
CONSENT to MEDICAL TREATMENT: In the event of an accident or emergency, I hereby authorize Rock With Me and Dance and its representatives, including its employees, contractors, teachers, coaches and volunteers, to render first aid to me or my child(ren) to the extent they deem appropriate for Emergency Medical Treatment should such a need arise and I am not present. I fully understand that this Emergency Medical Service shall only be for purposes of stabilization, and that my consent shall be required for all other services. I agree to hold Rock With Me and Dance and its representatives harmless from any and all decisions made with respect to medical and dental treatment for my child(ren).
Payment: We agree to pay the tuition in full at the time this form is presented.
I have read and understand this ASSUMPTION OF RISK and WAIVER OF AND RELEASE OF LIABILITY and PHOTO RELEASE , MEDICAL AUTHORIZATION AND PAYMENT FORM and my signature below indicates my voluntary agreement with the terms set forth above.
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