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Students entered below will be added to your family's account
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Liability Release
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I, the undersigned parent or guardian do hereby agree to allow the individual(s) named herein to participate in this activity/program and and I further agree on behalf of myself and my minor child/children/ward(s) that I understand that all forms of dance and conditioning includes physical movements. I understand that I will receive information and instruction: including verbal and physical adjustments about dance and conditioning. As in the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. It is my responsibility to consult with a physician prior to my participation in the dance class. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the dance class. I am aware I may be physically adjusted. I agree to take full responsibility for any risks, loss, claim, injury, damage or liability, known or unknown, which I might incur as a result of participating in the program. Dancing and conditioning is not a substitute for medical attention, examination, diagnosis or treatment. Dancing and conditioning is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to engage in dancing and/or conditioning. I knowingly, voluntarily, and expressly agree to accept full responsibility and assume the risk for my use of or participation in any and all classes, activities, apparatus, appliance, facility privilege or service of any nature, which is owned or operated by Southwest Ballet Theatre. While engaging in any class or activity operated, organized, arranged or sponsored by Southwest Ballet Theatre, either of off their premises, I shall do so at my own risk, and hold Southwest Ballet Theatre, its employees, representatives and agents, forever harmless from any and all loss, claim injury, damage, or liability sustained or incurred by me. I specifically agree to indemnify and hold harmless Southwest Ballet Theatre as to any loss, cost, claim, injury, damage or liability, sustained or incurred by participating in the classes, or through my use of the facilities or equipment of Southwest Ballet Theatre which is caused by an act or omission, whether negligent, intentional or otherwise, of an employee, representative, or agent of Southwest Ballet Theatre. I, my heirs, or legal representative forever release waive, discharge and covenant not to sue Southwest Ballet Theatre for any injury or death caused by my participation in the dance class.
I've read the above and agree.
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Photography Release
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In exchange for consideration received, I hereby give permission to Southwest Ballet Theatre to use mine/my child’s name and photographic likeness in all forms and media for advertising, trade, and any other lawful purposes. Southwest Ballet Theatre has informed me that intended use of photographs is for website, internet, and printed marketing material. I agree that if I receive copies of photographs, I will not publish, distribute, or sell them without written consent of Southwest Ballet Theatre.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Card Expiration Month: * |
Exp Year: *
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City:
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State:
Zip:*
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