Donna's Studio of Dance

Health Information and Medical Release/Waiver Form

I the parent/guardian of my student am aware that participation in dancing is potentially dangerous and involves risk of injury.I understand that these risks include, but are not limited to injury to ligaments, muscles, tendons, bones, and other aspects of the body that may include head, neck, or spine. Due to the dangers of this activity, I understand the importance of my child's following the teacher's instructions regarding techniques, training, and other rules and agree that my child will obey these instructions. In consideration for allowing my child to participate in Donna's Studio of Dance activities, I hereby assume all the risks associated with the sport of dance, and I agree to release Donna's Studio of Dance and its employees or agents from any and all liability/responsibility which may arise in connection with my child's participation in activities at Donna's Studio of Dance.

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

In the event that I cannot be reached, please call the following:

Release of Liability Form for Parent/Student

In consideration of my minor child being permitted to participate in dance/tumbling/theatre lessons, activities, and productions conducted by Donna's Studio of Dance, I acknowledge that I am aware that playing or practicing dance, tumbling & theatre steps and dance, tumbling& theatre exercises can lead to potential injuries that include, but are not limited to, injury to bones, joints, ligaments, muscles, and tendons. I understand there are dangers and risks of playing/practicing in dance/tumbling/theatre, just as there is in any physical sport or exercise. I understand that the dangers and risks of dance may result in serious impairment of my child's future abilities.

Because of the dangers of participating in dance, tumbling & theatre lessons, activities and productions,I

recognize the importance of guiding my child to follow the instructor's instructions regarding techniques, training, and other dance studio rules, etc., and agree to encourage my child to obey such instruction. I, also, agree to follow instructions and rules related to Donna's Studio of Dance.

In consideration of Donna's Studio of Dance permitting my child and me to participate in their dance, tumbling & theatre lessons and productions and to engage in all activities related to the program, I hereby assume all risk associated with my child's participation and agree to indemnify, defend, and hold Donna's Studio of Dance, Provenza Realty, Owner Donna Lamm, its Trustees, employees, instructors, agents, representatives, and volunteers harmless from any and all liability, actions, causes of action, debts, claims or demands of any kind and nature whatsoever which may arise by or in connection with my and/or my child's participation in dance activities, lessons and/ or productions.

I affirm that I am the parent/legal guardian of the minor child. I have read this warning and release and understand its terms. I understand that all dance, tumbling & theatre activities can involve RISK OF INJURY, including, but not limited to those outlined in this release. The terms hereof shall serve as a release for me, my heirs, estate, executor, administrator, assignees, and for all members of my family.

By signing I confirm I received a copy of Donna's Studio of Dance policies listed above and both myself and my student will abide by them.

I hereby acknowledge that I am aware of Donna's Studio of Dance payment obligations and policies, and understand when tuition is due. I understand that it is my responsibility to obtain the tuition amount due for my student's classes. I understand that if tuition owed is more than one month past due, my student will be asked to sit out during class and will not be able to participate in studio events, performances or recitals. Payment is due the FIRST week of the month. By signing below, I acknowledge that the information on the form above is accurate, that I may be needed in case of an emergency and that Donna's Studio of Dance may rely on the information provided. I further acknowledge that I have read, fully understand and agree to the terms and conditions of the Tuition Agreement above.

Parent Release Form for Media Recording
I, the undersigned parent/guardian of the above-named child, am granting permission to Donna’s Studio of Dance to use the image of my child. Such use includes the display, distribution, publication, transmission, or otherwise use ofphotographs, images, and/or video taken of my child for use in materials that include, but may not belimited to, printed materials such as brochures and newsletters, advertising, videos, and digitalimages such as those on Donna’s Studio of Dance website and social media. By signing this form, I understand that I am giving unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Donna’s Studio of Dance for a variety of purposes and that these images may be used without further notifying me. I do understand that the child’s name will not be used in conjunction with any video or digital images.