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MEDICAL RELEASE

In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by staff or emergency personnel. I also release Diversity Dance Studio and its staff of liability in case of injury or accident incurred to:

Child Name: ________________________________________________________________________________________
Medical Info/Health Concerns: ____________________________________________________________________
Parent/Guardian signature: ________________________________________________ Date: _________________

Diversity Dance Studio, LLC
Liability of Release

Child’s Name_________________________________________ Child’s Age________________________ Any Allergies?________________ If yes, please list ___________________________________________ Parent’s Names (Please list ALL guardians)___________________________________________________ Parents Phone # (Please list two contact #’s)_________________________________________________ Parents Email__________________________________________________________________________
Please list any other information you would like us to know about your child: _____________________________________________________________________________________ _____________________________________________________________________________________

Diversity Dance Studio Photo/Video Release:

We are constantly photographing/filming children to share with the public all the wonderful activities and events we do within the community. We may use these photos/videos in publications such as our website, Instagram, Facebook, local newspapers, flyers and other publications which are not limited to those listed above. Please Initial and sign below:
______ I give permission to use my child’s photo in any Diversity Dance Studio publication.
______ I do not give permission to use my child’s photo in any Diversity Dance Studio publication
Parent/Guardian Name:________________________________________________________________
Parent/Guardian Signature: _____________________________________________________________
Date: ____________
*Please note if you attend an event where filming or photos are being taken, we cannot guarantee your child will not be photographed or filmed in a group show. To guarantee this we advise that you do not participate in the event or make sure you keep an eye on your child.

Diversity Dance Studio Liability Release:

I acknowledge, understand and agree to release Diversity Dance Studio, LLC from liability and to indemnify and hold harmless Diversity Dance Studio, LLC, and any of its employees. This release is for all liability for personal injuries inside and outside of the classroom, lobby or studio (including death), property loss or damage occasioned by, or in connection with any activity or accommodations for this and all future events. The undersigned further agrees to abide by all the rules and regulations promulgated by the owner of the event and/or its affiliate groups and vendors throughout the event.
Parent/Guardian Name: ________________________________________________________________
Parent/Guardian Signature:_____________________________________________________________
Date: ____________