In an emergency situation, a medical technician may need to know the following information regarding my child’s health: allergies, chronic illnesses, seizures, etc. (see below notes)
_** Please notate on account__________________________________________
_**Please update/verify personal and Emergency contact information on your account________
*I/We, the parent/guardian of the registered student, a minor, and the registered student agree to the following:
*PHOTO/IMAGE RELEASE: I give my consent for images (photographs/videos)of my dependent to be taken and used to document the activities of Palmetto Dance Starz. I grant Palmetto Dance Starz permission to use the images for educational and promotional purposes. I understand that if I do not want images of my dependent to be used, I will indicate this in writing and the signed letter will be attached to my account file.
*MEDICAL RELEASE: I give my permission for Courtney Carroll, Studio Staff, or designated Studio Parent to provide emergency medical care in case of emergency as prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent. I accept full responsibility for all costs of said medical care and any emergency treatments. Palmetto Dance Starz will not be responsible for the cost of any medical care or emergency treatments. I hereby waive all claims whatsoever in connection with such medical treatments.
4. WAIVE AND RELEASE: I agree that if my dependent or I (heretofore known as “weâ€) engage in any physical, exercise, class, or activity, or facility on the premises or any venue where we participate as representatives of Palmetto Dance Starz, we do so at our own risk. I agree that we are voluntarily participating in activities and use of said facilities, premises (including the parking lot) and designated Palmetto Dance Starz venues. We assume all risk of injury, illness, damage, or loss to us or our property that might result, including, without limitation, any loss of theft of any personal property. I agree that this consent and assumption of risk statement covers each and every event of activity sponsored by Palmetto Dance Starz. I agree to release and discharge you (and your affiliates, employees, agents, representatives, successors, and assigns) from any and all claims or cause of action (known or unknown) arising out of your negligence. I acknowledge that I have carefully read this Waiver and Release and fully understand that this is a release of liability. I am waiving any right that I may have to bring legal action to assert a claim against you for your negligence.