I, the undersigned, on behalf of myself or a minor listed above, do hereby request enrollment in the Dance, Acrobatics/Gymnastics, and related Activities classes conducted by Faberge Follies. In consideration thereof I, for the minor and/or myself, our executors and assigns and other representatives do hereby release and hold harmless Faberge Follies and its owners from any and all claims, causes of action or suits which may result from the enrollment in these classes or any of the school's related functions, except for gross negligence on the part of Faberge Follies, while in or upon the premises or any premises under the control and supervision of Faberge Follies, its owners and staff or in route to or from any of said premises.
In the event of illness or injury, or if deemed necessary by the Faberge Follies staff, I hereby give my consent to Faberge Follies staff, volunteer or paid, to provide, through a medical staff of its choice, customary medical/athletic training attention, temporary first aid, transportation, and emergency medical services as warranted in the course of the minor's participation. I certify that I personally and/or my medical insurance carrier will be responsible for all expenses which are incurred in relation to any injury sustained during any Faberge Follies activity including but not limited to class, competition, performance, etc.
GRANT: For consideration which I acknowledge, I irrevocably grant to Faberge Follies ("Company") and Company's assigns, licensees, and successors the right to use my image and name in all forms and media including composite or modified representations for all purposes, including advertising, trade or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images.
RELEASE: I release Company and Company's assigns, licensees, and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. Company is permitted, although not obligated, to include my name as a credit in connection with the image.
Company is not obligated to utilize any of the rights granted in this agreement.
I have read and understood this agreement and I am over the age of 18. If signing for a minor I affirm that I am the parent and legal guardian of said minor named above. I have legal right to consent to and do consent to the terms and conditions of this image (model) release.
This agreement expresses the complete understanding of the parties.