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Dancing is a strenuous activity from which injuries could arise. Westmoreland Youth Ballet,
the teachers and employees are not liable for personal injuries, or loss of, or damage to
Each student may decline to participate in any activity. Please inform WYB and instructors of
any physical limitations you may have. If you are in doubt as to your physical abilities, please
consult your physician before participating.
*I affirm that I am, or my child is, physically able to participate in all activities, and has no
medical condition that would prevent him/her from taking part in workshop activities.
*I hereby authorize any and all medical attention to be administered to myself or child, in the
event of accident, injury, sickness, etc., under the direction of Westmoreland Youth Ballet,
until such time as I or the appointed emergency contact person may be contacted. I assume
the responsibility for the payment of any such treatment.
*I have notified WYB of any special medical needs or information required for myself or child.
* I, for myself, my child, my spouse, heirs, legal representatives and assigns, expressly release,
waive, discharge and hold harmless Westmoreland Youth Ballet, its officers, directors,
employees, teachers, agents, successors, predecessors, sponsors, legal representatives and
assigns from all claims, demands, losses, actions, judgments, suits, executions and liabilities of
any kind. In addition, this release is for the entire premises of Westmoreland Youth Ballet,
including but not limited to common areas, restrooms, changing rooms, studios, offices,
sidewalks, stairwells, elevators, parking areas and grounds and any other location where
classes will be held.
I hereby grant permission to Westmoreland Youth Ballet LLC to use
photographs and/or video of my child taken in the studio and during rehearsals and any
public performances in publications, news releases, web sites, online social media,and
in other communications related to the mission of Westmoreland Youth Ballet LLC.
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