PARENT/GUARDIAN INFORMATION (if student is under 18)

MEDICAL INFORMATION (Please use addition paper if necessary)

The following named people are to be contacted should the owner, instructor, staff, or volunteer be unable to reach a parent/guardian identified above and shall be authorized to act on behalf of the parents/guardians in the absence of the parents/guardians.

AUTHORIZATION TO OBTAIN MEDICAL TREATMENT IF NECESSARY, FOR STUDENT (18 or older) or AUTHORIATION FROM PARENT or GUARDIAN IF HE/SHE IS NOT ABILABLE TO MAKE THIS DECISION (if under 18 I give full permission to Music With Confidence, its owners, directors, staff, employees, independent contractors and/or volunteers, the legal right to choose or decide what medical attention should be provided should the need arise, when the student (under 18 years of age) cannot make this decision and the parent(s) is not present to make this decision.

RELEASE – MEDICAL EXPENSES AND FINANCIAL RESPONSIBILITY

I understand fully that either the student or performer, is or herself and/or parents/family and/or legal guardians whose names appear on page 1 and initials and signature appear below, is/are fully responsible for their own actions and the actions of the student and will be fully responsible for medical and/or dental care, financial responsibilities, bill and insurances should any injury occur while taking lessons, auditioning, rehearsing, or performing for/at Music With Confidence.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

IN CONSIDERATION OF my minor child/ward being allowed to participate in any way in the Music with Confidence classes, auditions, rehearsals, performances, events, or activities, the undersigned acknowledges, appreciates, and agrees that:

1)The risk of injury to my child/ward from the activities involved in Music with Confidence classes, events, and activities is significant, including the potential for permanent disability and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2)FOR MYSELF, SPOUSE/OTHER PARENT, AND CHILDWARD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both know and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE Music with Confidence Owner(s), Director(s), Staff, Employee(s), Independent Contractor(s), Volunteers and/or other, and assume full responsibility for my child’s/ward’s participation.

3) I willingly agree to comply with the program’s stated and customary terms and conditions for participation in Music With Confidence classes, auditions, rehearsals, performances, events, and activities. If I observe any unusual circumstances or have a significant concern regarding my child’s/ward’s readiness for participation in any class, rehearsal, performance, event, or activity, I will remove my child/ward from the Music With Confidence class, audition, rehearsal, performance, event, or other activity and bring such circumstance/ concern to the attention of the nearest Owner, Instructor, Staff Member, or Volunteer immediately; and

4) I myself, my spouse/other parent, my child/ward, and on behalf or my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE the other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct any Music With Confidence event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s/ward’s involvement or participation in Music with Confidence class, audition, rehearsal, performance, event, or activity, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

5) I, for myself, my spouse/other parent, my child/ward, and on behalf or my/our heirs, assign, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS Music With Confidence Owners(s), Director(s), Staff, Employee(s), Independent Contractor(s), Volunteers, others, and/or all of the above Releasees from any and all liabilities incident to my child’s/ward’s, as well as my own, involvement or participation in these Music With Confidence classes, auditions, rehearsals, performances, events, or activities, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

6) I understand the seriousness of the risks involved in participating in any Music with Confidence class, audition, rehearsal, performance, event, or activity, and my personal responsibilities for adhering to rules and regulations and accept them as a participant for myself and on behalf of my child/ward.

I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY INITIALLING AND OR SIGNING IT, AND INTIAL AND/OR SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Students, Family Members, or any other Representative agree not to disclose or reproduce any information regarding studio operations, choreography, staging, music, costumes, designs, and client lists, student information and family and/or contact information. This information is the property of Music With Confidence.

The Student, Family Member, or any other person associated with the student, who enters any studio, or any other premises used by Music With Confidence will be held responsible for any and all of their actions to include and or all damage to or loss of property belonging to Music With Confidence whether owned or rented, or any other person or party. The Responsible Party agrees to and will assume financial responsibility for the repair and/or replacement of any damaged and/or lost property of Music With Confidence or any other party.

A missed class may be made up by attending another class listed on the Music With Confidence schedule, preferably of the same style and age/ level within one week of the missed class. Any cancellation must be communicated to management at least 24 hours in advance of the lesson. If the cancellation notification is less than 24 hours in advance the responsible adult may be liable for the lesson fee

MUSIC WITH CONFIDENCE’S RIGHT TO MAKE CHANGES

Music With Confidence reserves the right to make changes of class schedules and/or instructions at any time.

I, the Student (if 18 or older), or Parent/Guardian (for students under 18 years of age) have filled out this form accurately. I have read, and fully accept and understand all sections, terms, and conditions of this Agreement.