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STUDENT___________________________________
PARENT’S/GUARDIANS____________________________________________________
PERSON
TO CONTACT IN CASE PARENT OR GUARDIAN IN UNAVAILABLE.
NAME_______________________RELATION_____________________PHONE___________
MEDICAL/LEGAL
CONCERNS_________________________________________________________________
MEDICAL/LIABILITY WAIVER
I
grant permission to the staff of the dance school to take first aid or
emergency measures as judged necessary for the care and protection of my
child while under the supervision of the school. In case of medical
emergency, I understand that my child will be transported to an
appropriate medical facility by the local emergency unit for treatment
if the emergency unit deems it necessary. I understand that in some
medical situations the staff will need to contact the emergency resource
before the child’s parent, physician, and or other person acting on
the parent’s behalf. I also understand and agree that the child’s
parents or legal guardians shall be responsible for any expenses
incurred. As the parent/legal guardian of _____________________ I agree
to hold harmless from any and all liability the school, its officers,
employees both in their professional capacity and personally for all
injury or illness resulting from or in any way connected with his/her
participation in the classes, activities or special events at the
school. I understand that it is the school’s policy that while under
the supervision of the school no child is allowed to leave the building
without a parent/legal guardian or the written permission of a
parent/legal guardian and that the parent/legal guardian assumes full
responsibility for the actions and behavior of the child. Parents/legal
guardians give their permission to the school to use photos and or video
of their child without payment in connection with school publications,
advertising, tv and news coverage. Registration is for the full
September to June dance season and all payments are nonrefundable.
SIGNATURE
OF PARENT/GUARDIAN___________________________________________
DATE________________
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