Photo Release and Liability Form

Please complete this form one time per year. Names of all dancers may be entered on this form.

PARENT/GUARDIAN NAME

PARTICIPANT NAME(S)

Photo Release

I give Goins Dancing permission to use mine and/or my child's picture in or any form of advertisement for Goins Dancing or any Goins Dancing-affiliated event.

Goins Dancing Liability Waiver

Please read and check off that you understand each of the following .

I understand that there are risks of physical injury/illness associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including all claims of negligence arising as a result of such activity from which liability could accrue to Goins Dancing, it’s officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to as “Goins Dancing”).

Pertaining to Minors

I am a parent and/or legal guardian of 1 or more minor children who will participate in dance activities/events with Goins Dancing.

The minor participant(s) has my permission to participate in Goins Dancing activities/events. I warrant the below information is complete and correct. I further release Goins Dancing of all liabilities associated with my child's attendance at Goins Dancing. 2

Participant or Parent/Guardian signature

Photo Release and Liability Waiver