Hold Harmless Release Form
RELEASE FORM, click on file, below, to download.
| health_release_form.pdf |
I release Road to Broadway LLC, during it’s event, The Road to Broadway Mini Dance Competition, the director Janet LaCava, it’s staff, and the East Greenville Fire Department, and all other associates from liability for harm, theft, or injury that may be suffered by me and/or members of my family traveling to or from or during participation in activities and programs sponsored by Road to Broadway LLC, and it’s event, The Road to Broadway Mini Dance Competition.
I hereby acknowledge that I am voluntarily assuming full responsibility for all risks of physical injury arising out of active participation in dance related activities. I acknowledge the contagious nature of contagious diseases and viruses and voluntarily assume the risk that I and/or my children may be exposed to or infected by contagious diseases by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families.
I release Road to Broadway LLC, during it’s event, The Road to Broadway Mini Dance Competition, director Janet LaCava, it’s staff, and the East Greenville Fire Department, and all other associates from liability for harm, injury or death pertaining to contagious diseases and viruses. I understand that there are NO refunds for entry fees, unless the event is canceled. I understand and agree to Road to Broadway LLC and it’s event, The Road to Broadway Mini Dance Competition policies and procedures. I give permission to Road to Broadway LLC, to use pictures and or video of my child for advertising purposes in print, promotional videos and on the website, for The Road to Broadway Mini Dance Competition.
Any damages, or loss, to the venue (floor, walls, doors, bathrooms, equipment}, are the financial responsibility of the persons, and/or studios, who caused said damages.
By signing, below, I state that I have read, understand, and agree with the above statements.
Please print the names of studio owners, teachers, competitors, parents, legal guardians, or any competitor who is 18 years of age, or older, plus their signatures and the date.
ANYONE ATTENDING MUST SIGN!
This form must be turned into The Road to Broadway Mini Dance Competition on, or before, the date of the scheduled dance competition.
Studio Owners, Teachers, and attendees, please print your name below, signature & date _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Parent/guardian/adult competitor/spectator, please print your name below, signature & date
Parents and guardians, please, also, print the name of your child, your signature & date
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I hereby acknowledge that I am voluntarily assuming full responsibility for all risks of physical injury arising out of active participation in dance related activities. I acknowledge the contagious nature of contagious diseases and viruses and voluntarily assume the risk that I and/or my children may be exposed to or infected by contagious diseases by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families.
I release Road to Broadway LLC, during it’s event, The Road to Broadway Mini Dance Competition, director Janet LaCava, it’s staff, and the East Greenville Fire Department, and all other associates from liability for harm, injury or death pertaining to contagious diseases and viruses. I understand that there are NO refunds for entry fees, unless the event is canceled. I understand and agree to Road to Broadway LLC and it’s event, The Road to Broadway Mini Dance Competition policies and procedures. I give permission to Road to Broadway LLC, to use pictures and or video of my child for advertising purposes in print, promotional videos and on the website, for The Road to Broadway Mini Dance Competition.
Any damages, or loss, to the venue (floor, walls, doors, bathrooms, equipment}, are the financial responsibility of the persons, and/or studios, who caused said damages.
By signing, below, I state that I have read, understand, and agree with the above statements.
Please print the names of studio owners, teachers, competitors, parents, legal guardians, or any competitor who is 18 years of age, or older, plus their signatures and the date.
ANYONE ATTENDING MUST SIGN!
This form must be turned into The Road to Broadway Mini Dance Competition on, or before, the date of the scheduled dance competition.
Studio Owners, Teachers, and attendees, please print your name below, signature & date _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Parent/guardian/adult competitor/spectator, please print your name below, signature & date
Parents and guardians, please, also, print the name of your child, your signature & date
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________