Medical Release 2023-2024


Jun 25, 2024 07:02 AM



Michele Winchester | Studio Owner | www.missmicheleandco.com
Miss Michele & Co.| 210 & 212 S. Front Street | Dowagiac, MI 49047


I, (parent/guardian's name), understand that dancing
and dance related activities present a risk of injury to the participant. I understand that there is an inherent risk of
injury that cannot be eliminated regardless of the care taken to avoid injury. I agree to assume that risk by
allowing my child (myself if 18 or older), to participate in these activities with Miss Michele & Co.

The undersigned acknowledges that the participant is in good health and does not have any history of a medical
or physical condition that would place the participant at risk due to the participant's medical or physical condition.
I do hereby release and forever discharge Miss Michele & Co., their predecessors and successors, employees,
agents and assigns, and all other persons, corporations, and entities from all claims, expenses, attorney fees, and
causes of action or suits of any kind or nature associated with the participant's involvement with activities
through Miss Michele & Co.

I further hereby give permission for any and all medical attention to be administered to my child in the event of
accident, injury, sickness, etc., under the direction of the physician(s) listed below or at any necessary emergency
facility, until such time as I may be contacted. I also assume the responsibility for the payment of any such
treatment. This release is effective for the period of one year from the date given below.

-Miss Michele & Co.