Pivot Dance Studio
Health Information and Medical Release/Waiver Form
I am aware that participation in dancing is potentially dangerous and involves risk of injury. I understand that these risks include, but are not limited to injury to ligaments, muscles, tendons, bones, and other aspects of the body that may include head, neck, or spine. Due to the dangers of this activity, I understand the importance of my child following the teacher's instructions regarding techniques, training, and other rules and agree that my child will obey these instructions. In consideration for allowing my child to participate Pivot Dance Studio's activities, I hereby assume all the risks associated with the sport of dance, and I agree to release Pivot Dance Studio and its employees or agents from any and all liability/responsibility which may arise in connection with my child's participation in activities at Pivot Dance Studio.
Insurance Company/Phone Number Policy Number:
Allergies/Special Health Considerations:
I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child. This authorization applies only in the event that neither parent/guardian can be reached in the case of an emergency.
Pivot Dance Studio
Parent Release Form for Media Recording
I, the undersigned, do hereby grant permission to Pivot Dance Studio to use the image of my child(children). Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, advertising, videos, and digital images such as those on Pivot Dance Studio's website and Facebook page and other social media websites.
By signing this form, I understand that I am giving unrestricted permission for my child's image to be used in print, video, and digital media. I agree that these images may be used by Pivot Dance Studio for a variety of purposes and that these images may be used without further notification. I do understand that the child's last name will not be used in conjunction with any video or digital images.