The Backstage Foundation Community Center Dance Program-MVCC Dance Class Sign Up & Waiver Form • Fall 2024

FREE DANCE CLASS SIGN UP

The Backstage Foundation Community Center Dance Class Program
Thursdays • Oct. - Nov.
Starts Oct. 3rd and Ends Dec. 5th

Location:

Mountain View Community Center

3607 122nd Ave E.

Edgewood, WA 98372

253.826.4329

No Dance Experience Necessary. Please wear comfortable clothes & tennis shoes (dancewear not required).
PARTICIPANT INFORMATION

To Be Filled Out By Parent/Guardian Of Participant
Participant's First Name*
Participant's Last Name*
Participant's Age*
City of Resience*
Are there any medical conditions or allergies, including food, that we should be aware of?*
Please Select a Class (no classes on Halloween and Thanksgiving). PLEASE NOTE the 5:00 PM Hip Hop/Jazz Combo Class for ages 6-11 is FULL.*

Hip Hop Teens: Ages 12-17 • Thursdays • 4:00 - 5:00 PM
List the First & Last Name of Adults Authorized To Pick Up Your Child From Dance Class*
How Did You Hear About The Event? Please Select All that Apply.*

The Backstage WebsiteMountain View CC WebsiteFacebookSeeds Of Change DinnersOther
I would like to subscribe to The Backstage Foundation Email Newsletter to stay informed on all of The Backstage Foundation's latest news.*

YesNoI have already subscribed
PARENT/GUARDIAN INFORMATION:
Parent/Guardian First Name *
Parent/Guardian Last Name*
Parent/Guardian Phone Number*
Parent/Guardian Email*
EMERGENCY CONTACT INFORMATION:
Emergency Contact First Name*
Emergency Contact Last Name*
Emergency Contact Phone Number*
Relationship to Participant*

THE BACKSTAGE FOUNDATION

PARTICIPANT WAIVER & AGREEMENT
Type a question
THE BACKSTAGE FOUNDATION
Community Center Dance Program Participant Waiver & Agreement

Awareness and Assumption of Risk
I acknowledge that participating at The Backstage Foundation’s Community Center programs/events have risks. These risks may arise in a variety of ways, including from:
· Physical exertion, injury
· Working in a theater/on stage
· Exposure to loud noise, bright lights, crowds,
weather conditions
· Interacting with or being in the presence of other volunteers, visitors, children, dancers, or others
· Exposure to COVID-19 or other infectious disease

I assume and accept any and all risks of injury, illness, death, and property damage or loss that may arise from my presence at The Backstage Foundation’s facilities/programs/events.

Waiver and Release of Claims
I waive and release The Backstage Foundation and its directors, employees, other volunteers, and venue from any and all claims and liabilities arising from my participation at The Backstage Foundation's Community Center programs/events including, without limitation, claims in respect of death, illness, or injury to my person or property. I will not sue The Backstage Foundation on the basis of these waived and released claims.

Disclosure of Medical Conditions
I understand that I am solely responsible for knowing my own physical condition and making my own decision about participating/dancing/volunteering. I have disclosed all medications and conditions relevant to my participation to The Backstage Foundation team, including, without limitation, chronic conditions such as asthma, allergies, seizures, or diabetes. I understand that The Backstage Foundation needs such information because some medication side effects, or medical conditions could affect my safety or that of others at The Backstage Foundation’s Community Center programs/events. I consent to The Backstage Foundation sharing this information with health professionals or first responders should I become ill or injured while participating in The Backstage Foundation’s Community Center programs/events.

Use by The Backstage Foundation of My Name and Image
I consent to use by The Backstage Foundation of my image, voice, name, video, and story, and of images of any works used during The Backstage Foundation's Community Center programs/events, in The Backstage Foundation’s digital and print promotional, fundraising, educational, social media and other communications. The Backstage Foundation may use them without obtaining my approval or paying me for such use. Choreography shall remain the property of the programs/events choreographer, as such it will not be re-taught or used by other dancers, however, the Backstage Foundation reserves the right to display it without compensation. I waive any legal claims related to such use, including claims relating to copyright or rights of publicity or privacy.

Medical Care Consent
I authorize The Backstage Foundation to provide me first aid, emergency medical assistance, and transportation. I understand that The Backstage Foundation is not obligated to provide this care. I also understand that I am solely responsible for any costs related to my medical treatment and transport, and that The Backstage Foundation does not provide health, medical, disability, or other insurance coverage for me.

Cancellations
I understand that The Backstage Foundation is not liable should a program or event be cancelled due to inclement weather conditions, pandemic, natural disaster, or any other condition beyond their control. I understand that The Backstage Foundation will give as much notice as possible should these conditions arise.

Applicable to All Participants
I understand this Waiver & Agreement applies throughout the duration of my participation at any and all of The Backstage Foundation’s Community Center programs/events.

Safety and Conduct
I will comply with The Backstage Foundation's policies, safety rules, conduct expectations, and other directions. I understand that The Backstage Foundation does not tolerate bullying, harassment, threatening behavior, or violence of any kind from its participants and/or their parents, guardians, invitees, or associates. The Backstage Foundation, in its full discretion, reserves the right to terminate my participation at Backstage Foundation events or disallow me from representing the Backstage Foundation at events hosted by third parties, immediately upon learning of allegations of bullying, harassment, threatening behaviors, or violence towards any person, whether affiliated with The Backstage Foundation or not.

This paragraph extends to PARENTS and LEGAL GUARDIANS of participants of The Backstage Foundation.

General Provisions
This Agreement will run in favor of The Backstage Foundation and its board, directors, employees, and other volunteers, and will bind my heirs, next of kin, and legal representatives. If any provision of this Agreement is found to be unenforceable, the other terms will remain effective.

No oral agreements have been made between the parties. The waiver or failure of either party to exercise, in any respect, any right provided in this Agreement shall not be deemed a waiver of any other right or remedy to which the party may be entitled. This Agreement shall be construed and interpreted in accordance with the laws of the State of Washington, without regard to residence of the recipient.

By signing & submitting The Backstage Foundation Community Center Dance Programs Participant Waiver and Agreement, you are certifying that you have read and fully accept and understand the terms and conditions of this Participant Waiver and Agreement. And that you understand that becoming a participant creates a binding agreement to these terms and conditions. In addition, you are certifying that all information is correct and that you are the person completing this Participant Waiver and Agreement for you or as the parent/guardian. When you press the submit button, you will receive an email copy of your Participant Waiver and Agreement form.

PLEASE NOTE: All participants aged 16 years and older are required to sign the Participant Waiver & Agreement Form. A parent/guardian's signature is also required for all participants UNDER the age of 18 Years Old.

Revised 2.20.2024
Parent/Guardian Full Name*
Parent/Guardian's Signature*

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Participant Signature if 16 yrs. or older

Clear
Today's Date*

MonthDayYear
Date

MOUNTAIN VIEW COMMUNITY CENTER

Youth Dance Participant Waiver
Type a question
Parent/Guardian will be asked to sign the waivers and releases listed below on the first day of dance lessons. This requires that youth's parent/guardian handle drop off on the first day of the dance session. Youth will not be able to participate unless waivers are signed by parent/guardian.
__________________________________________________________

Photo Release (optional):
I, as parent/guardian of all registered youth, grant full permission to Mountain View Community Center to use photographs and video recording of registered youth for promotion of this or any other MVCC event.
I agree to the Photo Release Waiver*
Please select yes or no
General Liability Release (Mandatory):
I, as parent/guardian of all registered youth, hereby assume all risks and hazards incidental to the conduct of the activities at Mountain View Community Center. My child/children are a good fit for the program(s) in which I have enrolled him/her/them. In the event of accident or illness, I understand that every reasonable effort will be made to contact me immediately. However, if I am not available, I authorize MVCC volunteers or employees to secure medical care as needed. In addition, I accept full responsibility for the cost of treatment and I release and discharge volunteers and employees of MVCC and any sponsoring organizations from all and any claims for personal injuries. The Mountain View Community Center does not retain medical personnel. I understand that medical equipment and personnel may not be on site. I further recognize that any assistance rendered is provided by volunteers and release such volunteers from any liability for care provided by them acting in good faith as Samaritans without expectation of compensation, within the limits of their training. 
I agree to the General Liability Release*
Please select yes or no
COVID Liability Release (Mandatory):
We are doing everything we can to be compliant with all regulations and ensure the safety of participants and volunteers. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.

I, as parent/guardian of all registered youth, hereby release, covenant not to sue, discharge, and hold harmless Mountain View Community Center, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any hosted or programmed event by this organization. 
I agree to the COVID Liability Release*
Please select yes or no
I have read and understand the Mountain View Community Center Youth Dance Participant Waiver - Parent/Guardian Full Name*
Parent/Guardian's Signature *

Clear
PLEASE NOTE: All participants aged 16 years and older are required to sign the Participant Waiver & Agreement Form. A parent/guardian's signature is also required for all participants UNDER the age of 18 Years Old.
Participant's Signature if 16 yrs or older.

Clear
Today's Date*

MonthDayYear
Date
The Backstage Foundation is committed to equal opportunity in employment and education. The Foundation does not discriminate in any program or activity on the basis of race, color, religion, sex, gender, sexual orientation, gender identity, age, national origin, disability, marital status, or any other protected class.
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FREE DANCE CLASS SIGN UP

PARTICIPANT INFORMATION

PARENT/GUARDIAN INFORMATION:

EMERGENCY CONTACT INFORMATION:

THE BACKSTAGE FOUNDATION

MOUNTAIN VIEW COMMUNITY CENTER