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Waiver of Liability |
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I hereby release, indemnify and hold harmless Jersey City Dance Academy, Inc, its owners, members, advisors, Board of Directors, and all employees and agents of these parties from all liabilities, suits, claims. and/or demands of any kind or nature, legal or financial, whether caused in any way by the negligence or not, arising from the participation in or observation of any Jersey City Dance Academy, Inc. activity for injuries to any person or property, whether on or off the premises. The student/participant named below does voluntarily participate in any and all Jersey City Dance Academy, Inc. activities and that the student/participant and I understand that certain risks are inherent to and from participation and involvement with Jersey City Dance Academy, Inc. and in its various formal and informal activities. These activities include but are not limited to Dance and Gymnastics. Jersey City Dance Academy, Inc. is not responsible for any lost or stolen property, at any time. Anyone found to be violating any of the rules, codes of conduct, or found to be disruptive to either another individual or group may be asked to leave the premises or off-site location at any time and be refused reentrance without any full or partial refund. |
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Medical Release |
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As the parent/legal guardian of the student/participant named below, I request and authorize that in my absence the student/participant named below be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine/Osteopathy or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the student/participant named below. I have not been given any guarantee as to the results of examination or treatment. I hereby authorize Jersey City Dance Academy, Inc, its owners, members, Board of Directors, and all employees and agents of these parties to act for the student/participant named below according to their best judgment in providing or arranging for emergency care in any emergency circumstance requiring medical attention. I authorize the hospital, medical or care facility to dispose of any specimen or tissue during the course of any diagnosis, treatment or other normal and customary procedures. |
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Photo Release |
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I hereby understand and am fully aware that the student/participant named below may be participating in Jersey City Dance Academy, Inc. activities in which I and/or the student/participant named below may be photographed or videotaped (the Property) from time to time. I hereby irrevocably grant to Jersey City Dance Academy, Inc. perpetually, exclusively, and for all media throughout the world (including print, non theatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs, sound bites or video footage taken as a result of participation in Jersey City Dance Academy, Inc. activities. I hereby agree that I will not bring or consent to others bringing claim or action against Jersey City Dance Academy, Inc. on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on me or the student/participant named below, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release Jersey City Dance Academy, Inc, its owners, members, Board of Directors, and all employees and agents of these parties from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have against Jersey City Dance Academy, Inc. in connection with the Property. This agreement shall not obligate Jersey City Dance Academy, Inc. to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Property. Jersey City Dance Academy, Inc. shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, corporation or organization |
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Student/Participant: _________________________________
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(if student is 18 or older) (signature)
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_____ / ____ / ______ _________________________________
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(mm) (dd) (yyyy) (print name)
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Parent/Legal Guardian: _________________________________
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(if student is under 18) (signature)
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_____ / ____ / ______ _________________________________
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(mm) (dd) (yyyy) (print name)
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