Release of Liability and Medical Emergency Information
Participant _______________________________________________________
(Print Name)
As the legal parent or guardian, I release and hold harmless Molly Myers Dance
Academy, LLC, its owners, operators and landlords from any and all liability,
claims, demands and cause of action whatsoever, arising out of or related to any
loss, damage, or injury, including death, that may be sustained by the participant
and/or the undersigned, while in or upon the premises or any premises under the
control and supervision of Molly Myers Dance Academy, LLC, its owners,
operators, or landlords.
I, the undersigned, give permission to Molly Myers Dance Academy, LLC, its
owners, and operators to seek medical treatment for the participant in the event
they are not able to reach the parent or guardian. I hereby declare the participant
to be in good physical and mental health.
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