-I, the undersigned, do not hold Fort Wayne Ballet, Inc., or any of its employees, staff or guest faculty responsible for
any accidents that may happen by nature of the physical activity engaged in on these premises.
-I understand that the art of dance and nature of dance instruction may sometimes require a teacher to touch my
child/me. I also understand that this will happen in a caring, gentle and appropriate manner.
-I hereby grant the staff of Fort Wayne Ballet, Inc., permission to administer first aid help, and/or call the
student’s physician, and/or call 911 in case of a medical emergency while attending classes or rehearsals
at Fort Wayne Ballet or rehearsal for performances off-site. Fort Wayne Ballet will attempt to first notify
parents or guardians in the case of an emergency (see Consent for Treatment form).
-I have read and accept the tuition policy (found in my registration packet). I understand that I am
responsible for the full tuition for which the above student is registered.
-I hereby grant the staff of Fort Wayne Ballet, Inc., permission to administer Ibuprofen or Acetaminophen
upon my child’s request.
I authorize and give consent to Fort Wayne Ballet, Inc., the use and reproduction of any and all
photographs taken of my student for samples, displays, promotions, advertisements and other legitimate
purposes without compensation.
