Registration

Emergency Contact

Release of Liability

In consideration of dancer mentioned above and the right of to participate in any Ballet Renaissance activities, I do hear by agree to waive, relinquish and to hold Ballet Renaissance and its Board of Directors, agents, employees and volunteers harmless and free from any and all liability with my child’s participation in the above Ballet Renaissance activities.In making this release and waive of liability, I am fully aware of the hazards and physical stress, and I declare that my child suers no medical or mental condition that would prohibit him or her from safely participating in this activity. Finally, I declare that I have disclosed to Ballet Renaissance (below) the nature of any existing physical or mental conditions which may interfere with my child’s participation in Ballet Renaissance activities, and that in the future, I will inform Ballet Renaissance of any physical or mental conditions which my child incurs during the period of enrollmentin Ballet Renaissance activities which may interfere with my child’s participation in such.

Release of Liability (Dancer / Parent / Guardian) Signature

Photo Release

This form gives Ballet Renaissance permission to use pictures of dancer mention above for promotional and related materials. For valuable consideration, I hereby confer on Ballet Renaissance and Ballet Renaissance photographers, the absolute and irrevocable right and permission with respect to the photographs that are taken of dancer listed above in which he/she may be included with others: a) To copyright the same in photographer’s and/or Ballet Renaissancename or any other name that he/she may select; b) To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration,promotion, advertising and trade, and; c) To use dancers name in connection therewith if he/she so decides. I hereby release and discharge Ballet Renaissance and Ballet Renaissance photographers, from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of Ballet Renaissance and Ballet Renaissance photographers, as well as the person(s) for whom he/she took the photographs. I have read the foregoing and fully understand the contents hereof. I represent that I am the [parent/guardian] of the above named dancer / I am a dancer of legal age. For value received, I hereby consent to the foregoing on his/her behalf.

Photo Release (Dancer / Parent / Guardian) Signature