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    Additional Info.

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    1. Please fill out the following questions. By submitting this form, you are agreeing to the following:

      Waiver of Liability
      Safety is the main objective, but any activity involving motion has a chance of accidental injury. I, the undersigned parent or legal guardian of participant(s) listed, do hereby give permission for the aforementioned persons to participate in any and all classes, programs, shows and events offered by or attended by Core Dance. I accept all risks associated with that participation and understand that there is a full possibility of serious physical illness or injury. I hereby covenant not to sue and waive, release and forever discharge any and all rights and claims for damages, which may arise now or in the future against Core Dance and its officers, owners, directors, employees, the owner of the facility in which Core Dance exists and/or other assigned representatives or volunteers from any and all liability and for any and all damages and/or injuries which may be sustained or suffered by the participant(s) while participating at or for Core Dance. Furthermore, I hereby give my permission to Core Dance to use photographs and/or videos of the participant(s) as deemed appropriate for the promotion of Core Dance.

      Insurance and Permission for Treatment
      Core Dance does not carry medical insurance for its students. It is required that all students be covered by their own family insurance policy and it is understood that if injury does occur, the student's own policy is your only source of reimbursement. This is my certification that I have medical insurance on the participant(s) and will maintain continuous medical coverage while he/she is at Core Dance. I also authorize Core Dance and its owners, employees, directors, etc. to use standard first aid procedures on the participant(s) and to consent any other medical procedure that is deemed necessary in the case of an emergency. Furthermore, I certify that I personally and/or my medical insurance carrier will be responsible for all expenses which are incurred in relation to any injury sustained during any Core Dance related activity included by not limited to a Core Dance class, show, etc. 
      1. Does the participant have allergies? *
      2. If yes, list here.
      3. Any current medical conditions? *
      4. If yes, list here.
      5. Any current medications? *
      6. If yes, list here.
      7. Family Physician *
      8. Physician Phone # *
      9. Emergency Contact (other than Guardian and Relationship to Student) *
      10. Emergency Contact Phone # *
      11. Guardian Name *
      12. Guardian Phone Number *
      13. Participant Age *

    Your registration to Teens Activate 2020.

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    The Home Stretch.

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    I hereby give my consent for the above named student to complete and participate in Core Dance’s Teens Activate Summer Program. I hereby release and discharge Core Dance, including their officers, employers, participants, and volunteers (herein collectively referred to as Core Dance) from all liability arising out of or in connection with the above described activity or all liabilities associated with any and all claims related to such activity that may be filed on behalf of or for the above named minor. For the purposes of this agreement, liability means all claims, demands, losses, causes of action, suits or judgments of any and every kind that occur during the above described activity and that result from any cause including the active or passive conduct and/or negligence of Core Dance.
    I acknowledge on my behalf and on the behalf of the above named minor that there are risks inherent in the above-described activity, including the risk of serious injury that may occur through the conduct of other participants, instructors, Core Dance, including conduct that may not be part of the ordinary risks of the activity itself. For example, injury may occur through conduct that is not authorized by the rules and regulations of the activity. This release and waiver as set forth in the above paragraph shall also apply to this type of conduct and any resulting injury.

    I also represent that the above name participant has undergone a medical examination by a licensed physician within one year preceding the date this document is signed, in good health, and fully able to participate in the activities provided by the camp, including activities which are strenuous in nature.

    We, the parents of the above child, herby give my/our approval for her/his participation in activities during the current session. We assume all risks and hazards incidental to the activities and transportation to and from the activities. In case of injury to my child, I/We hereby waive all claims against Core Dance, the owner, instructors, and employees. I/We release from responsibility any person transporting my child to the doctor, or hospital in case of injury.

    We agree to pay the dance camp fee at the time this form is presented. Please note that summer dance camp can be cancelled due to lack of participation, in this event, a full refund will be issued to the payer. In the event the student registered above decides to discontinue camp mid-session, I will inform Core Dance by phone or email and I understand that I will not receive any refunds.

    I have carefully read this waiver and release of liability and fully understand its terms and condition and understand that by signing this document that I have given up substantial rights for the named participant/minor and myself.


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