The health history I have provided is correct and accurately reflects the health status of the student to whom it pertains. The person described has permission to participate in all program activiteis except as noted by me and/or an examining physician. I give permission to the physician selected by The School of New England Ballet Theatre to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I can not be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injections, anesthesia, or surgery for this child. I understand the information on this form will be shared on a "need to know" basis with program staff. In addition, the program has permission to obtain a copy of my child's health record from providers who treat my child and these providers may talk with New England Ballet Theatre staff about my child's health status.

I am aware that dance and the nature of the training and performing associated with this program places unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and myself (and if I am no longer a minor, on my own behalf), I assume the risk and agree that New England Ballet Theatre and The School and the staff of this institution shall not be liable in any way for injuries sustained during attendance at this program or any of its related functions.

It is also understood that dance instruction involves kinetic corrections that may include physically touching a student as part of regular class work and rehearsals. Students who have concerns about this should speak with their instructors prior to individual classes.

I understand that The School of New England Ballet Theatre may take photo and video recordings of me during my participation in The School’s classes and activities. I convey to The School of New England Ballet Theatre full rights and interest in these recordings. I understand such recordings may be used in advertising or other published materials, physical or virtual. If I do NOT consent to being photographed or video-recorded, I will make sure the Director is aware of my concerns and the reasons for them. I will be proactive about avoiding being photographed or recorded, and I will hold The School of New England Ballet Theatre harmless if a photo or video recording of me is released despite all precautions. I understand that this choice may limit my participation in performances that are routinely photographed and/or videotaped.