coastal arts academy SPRING BREAK camp Registration

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby grant permission for my child to participate in any and all activities organized by Coastal Arts Academy, Ilha Ballet, Éclat Dance, and Jessa Pereira during the selected camp. In consideration of my child’s acceptance and participation, I acknowledge and assume all risks and hazards incidental to such activities and hereby release, absolve, and hold harmless Coastal Arts Academy, Ilha Ballet, Éclat Dance, and Jessa Pereira, along with their officers, directors, agents, representatives, coaches, and affiliates, from any and all liability for injuries to my child arising from traveling to, participating in, or returning from camp sessions.

In the event of injury to my child, I expressly waive any and all claims against Coastal Arts Academy, Ilha Ballet, Éclat Dance, and Jessa Pereira, including claims against coaches, affiliates, participants, sponsoring agencies, advertisers, and, where applicable, owners and lessors of premises used for the activities.

I understand that participation in sports and physical activities, including dance, involves inherent risks. These risks may include, but are not limited to, physical injury such as sprains, fractures, paralysis, or, in rare cases, death. I acknowledge these risks and voluntarily agree to allow my child to participate.

Medical Release and Authorization

As the parent and/or legal guardian of the named athlete, I hereby authorize the diagnosis and treatment of my minor child by a qualified and licensed medical professional in the event of a medical emergency. This authorization applies when, in the opinion of the attending medical professional, immediate medical attention is required to prevent further risk to the child’s life, physical disfigurement, physical impairment, or undue pain, suffering, or discomfort.

I grant permission to the attending physician to administer any necessary medical treatment, including minor surgical procedures, X-ray examinations, and immunizations, for the named athlete. In the event of a serious illness, major surgery, or significant accidental injury, I understand that every reasonable effort will be made by the attending medical professional to contact me as quickly as possible. This authorization applies only after reasonable attempts to reach me have been made.

I further grant permission to Coastal Arts Academy, Ilha Ballet, Éclat Dance, Jessa Pereira, and their affiliates, including directors, coaches, and team parents, to provide or arrange necessary emergency care prior to the child’s admission to a medical facility.

This authorization is valid for the dates and/or duration of the registered season.

I acknowledge that this release is executed voluntarily and of my own free will for the sole purpose of authorizing emergency medical treatment for the protection of the life and health of my minor child in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.