Student Name * First Name Last Name Emergency Contact Name * First Name Last Name Emergency Phone Number * (###) ### #### Please list any medications/allergies/special notes we should be aware of Ballet Hartford takes every precaution to provide an injury-free experience for its artists and students. In the event of dancer injury or accident, Ballet Hartford assumes no responsibility, financial or otherwise. I hereby waive and release all rights and claims against Ballet Hartford and its employees, directors, and associates from any damages or injuries sustained by myself or my child in classes, on studio premises, or at any outside studio event. I hereby release and agree to hold Ballet Hartford harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of actions, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by an act, or failure to act of Ballet Hartford or that may otherwise arise in any way in connection with any services received from Ballet Hartford. I understand that this release discharges Ballet Hartford from any liability or claim that I, my heirs, or any personal representatives may have against the studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Ballet Hartford. This liability waiver and release extends to the studio together with all owners, partners, and employees. Please initial below in recognition of agreement: * I hereby give permission for images of my child, captured during Ballet Hartford classes/shows/events through video, photo and digital camera, to be used solely for the purposes of Ballet Hartford promotional material and publications, and waive any rights of compensation or ownership thereto. Please initial below in recognition of agreement * Thank you!
