L.E.A.P. Dance Company Liability & Media Release Form

L.E.A.P. Dance Company Liability & Media Release Form
1. Contact Information

Enter Parent/Guardian information if dancer is under the age of 18
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Dancer's Name #1 (if different from above)

First NameLast Name
Dancer's Name #2 (if different from above)

First NameLast Name
Dancer's Name #3 (if different from above)

First NameLast Name
Dancer's Name #4 (if different from above)

First NameLast Name
Relationship to Dancer*
If you selected 'Other', please provide details.
2. General Liability Waiver

Waiver of Liability & Assumption of Risk
I acknowledge that participation in L.E.A.P. Dance Program classes involves physical activity and movement that may result in injury or accidents. By signing this agreement, I voluntarily assume all risks associated with participation and agree that L.E.A.P., its instructors, and affiliates are not responsible for any injuries, accidents, or medical expenses that may occur.

✔ I understand that it is my responsibility to consult a physician before participating in physical activities.
✔ I release L.E.A.P. from any liability, claims, or demands for injuries sustained while participating in classes or events.
Check Here*

I agree to the terms above.
3. Photo & Video Release

Permission to Photograph & Record
I grant L.E.A.P. permission to photograph, record, and use images/videos of me (or my child) for promotional purposes, including but not limited to:
✔ L.E.A.P.’s official website
✔ Social media platforms (Facebook, Instagram, etc.)
✔ Marketing materials & advertisements
✔ Event promotions

I understand that these materials may be used indefinitely and waive any rights to compensation or claims related to their use.
Check Here*

I agree to the terms above.
Acknowledgement & Signature

By signing below, I confirm that I have read and agree to the Liability Waiver & Media Release.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

L.E.A.P. Dance Company Liability & Media Release Form

1. Contact Information

2. General Liability Waiver

3. Photo & Video Release

Acknowledgement & Signature