The undersigned represents to Tarrytown Dance Center, Inc. of Austin, Texas, and its shareholders, officers, employees, instructors, and other representatives whether paid or volunteer (collectively the “Centerâ€), that the undersigned is a parent or legal guardian of the child named below and is fully responsible for the care and well being of said child. The undersigned confirms that there are no mental or physical problems or limitations associated with said child’s participation in the programs of the Center.
The undersigned hereby authorizes the Center to obtain medical assistance (or administer simple first aid in the event of minor injuries) and to provide transportation for a said child in the event of any illness or injury to a said child while on the premises of the Center or otherwise in the care of the Center. In connection therewith, if the undersigned parent or legal guardian cannot make timely arrangements for emergency medical attention in the event of any illness or accident of said child while in the care of the Center, I hereby authorize the Center to take my child to the doctor on file or the nearest hospital, where medication or procedures such healthcare providers may deem necessary for said child’s well being may be administered. The undersigned further agrees to be financially responsible for all such medical services.
The undersigned acknowledges and agrees that the Center shall not be liable for any losses, liabilities, claims, causes of action or damages of whatever nature, whether foreseen or unforeseen, direct or indirect, REGARDLESS OF WHETHER ANY SUCH LOSS, LIABILITY, CLAIM, CAUSE OF ACTION OR DAMAGE RESULTS FROM THE NEGLIGENCE OF THE CENTER, BUT SPECIFICALLY EXCLUDING THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF THE CENTER, ITS SHAREHOLDERS, OFFICERS, EMPLOYEES, AGENTS, INSTRUCTORS OR OTHER REPRESENTATIVES, that may arise in or to the benefit of the undersigned, in the name of or for the benefit of said child, or in the name of or for the benefit of any other person as a result of personal injury to said child while on the premises of the Center or otherwise in the care of the Center, including without limitation, any injuries sustained while said child is being transported as herein authorized, and in connection therewith, the undersigned, on behalf of himself/herself, said child and any other parent or guardian of said child, hereby knowingly, intentionally and willfully RELEASES and DISCHARGES the Center from any and all of said losses, liabilities, claims, causes of action or damages.
In furtherance of the foregoing, the undersigned hereby agrees to indemnify and hold harmless the Center from and against any and all damages, claims, causes of action, liabilities, losses, suits, costs or expenses (including court costs and reasonable attorneys' fees and disbursements) of whatever nature which may arise from any injury to said child while participating in programs of the Center or being transported or medically treated as authorized herein, REGARDLESS OF WHETHER ANY SUCH LOSS, LIABILITY, CLAIM, CAUSE OF ACTION OR DAMAGE RESULTS FROM THE NEGLIGENCE OF THE CENTER, BUT SPECIFICALLY EXCLUDING THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF THE CENTER, ITS SHAREHOLDERS, OFFICERS, EMPLOYEES, AGENTS, INSTRUCTORS OR OTHER REPRESENTATIVES.
If one or more provisions of this instrument are held to be invalid, illegal or unenforceable under applicable law, such invalid, illegal or unenforceable provisions in their entirety or portions thereof, to the extent necessary, shall be severed from this instrument, and the balance of this instrument shall be enforceable in accordance with its terms.
The undersigned acknowledges that the child named below will or may be videotaped or photographed by the Center for educational, performance, or promotional purposes, and any likeness of the said child may be used by the Center for promotional purposes without further consent and without payment of any compensation by the Center to a said child or any other person. I have read the foregoing Release and Medical Care/Transportation Authorization and fully agree with and understand it in all respects.