Dazzle, BBC LLC Waiver Form

Parent Name *

First Name Last Name

Student Name *

First Name Last Name

Student Date of Birth *

Month Day Year

Parent E-mail *

example@example.com

Dazzl'es Mission *

Parent/Guardian Agreement As the Parent/Guardian I am committing to Dazzle’s Mission and Developmental Movement program for my child or children. I understand that my child’s participation in this program is important to his or her overall growth and development.

Guardian Signature: * Parent Accepts Commitment *

Clear

Release and Waiver *

Release and Waiver I understand the medical risk that may result from such participation in physical activity, and I represent to Dazzle that my child is physically capable of participation without illness or injury. I voluntarily assume full responsibility for any risks or loss, property damage, or personal injury, including death that may be sustained by my child, or loss of damage to property owned by my child, as a result of participation in this dance program. I hereby release, waive, discharge and covenant not to sue Dazzle, its teachers, staff members, and facility owners now or in the future against all claims, actions, causes of actions as a result of damages, costs, liabilities, expenses, or judgments, including but not limited to attorney fees and court cost arising from or out of my child’s participation in any of the programs offered. I understand & accept

Guardian Signature: * Parent understands/accepts Release & Waiver* *

Clear

Promotional Use *

Promotional Use I give full consent and understand that my child (Parent/Guardian) as well as my child’s picture/video may be used in promotional material.

Guardian Signature: * Parent gives consent to use pictures and or video for promotion use ONLY *

Clear