Inferno Cheer and Dance ENROLMENT Contract/Waiver/Release, Medical Release & Appearance Form – 2020
PARTICIPANTS, PARENTS/GUARDIANS — READ BEFORE SIGNING PLEASE PRINT CLEARLY
School /Club /Gym Name INFERNO CHEER AND DANCE
In consideration of _____________________________ (student name), participating in any way in Inferno Cheer and Dance programs, classes and activities, the undersigned acknowledges, and agrees that: I, the undersigned parent or legal guardian, do hereby grant permission for my son/daughter to participate in any 2020 Inferno Cheer and Dance program, class and/or activity.
I further acknowledge and understand and agree that by participating in Inferno Cheer and Dance programs there is a possibility of physical illness or injury (minimal, serious, and catastrophic) and that my son/daughter is assuming the risk of such injury by participating. I authorise any representative of Inferno Cheer and Dance to consent and authorize any medical attention, treatment, surgery or administration of drugs by qualified and licensed medical personnel for my son/daughter, which may become necessary.
I understand I will be notified as soon as possible in the event of an emergency. I understand and agree that all expenses of such treatment are my responsibility.
I agree to protect, defend, indemnify and hold Inferno Cheer and Dance, including its staff, employees and sponsors from and against any and all claims, demand, losses, suits, liabilities, costs, or other damages including court costs and attorney’s fees, arising from any injury to, or death of son/daughter, the undersigned, or any other persons or damage to or destruction of property arising out of or in connection with any damage to third parties occasioned by, incident to, arising out of, or in connection with my son/daughter’s participation.
I willingly agree to comply with Inferno Cheer and Dance stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately.
I understand that Inferno Cheer and Dance may produce promotional material about the program. I understand that my son/daughter may be included in videotape or photography, taken during the program. I hereby grant Inferno Cheer and Dance, its successors, assignees, licensees, sponsors, any television networks and all other commercial exhibitors the exclusive right to photograph and/or videotape my son/daughter and further to utilize my son/daughter’s name, face, likeness, voice and appearance as part of the program, and in advertising and promotion of the program and business.
Rules / Regulations
- No smoking, consumption of alcoholic beverages or use of illegal drugs allowed.
- Inferno Cheer and Dance reserve the right to discipline any participant for unruly behaviour or for conduct unbecoming to the program.
- Participants & parents/guardians have read and understood the “Information Pack 2020” and agree to respect all program financial matters, rules, regulations and codes of conduct, and must obey all rules and regulations set forth by Inferno Cheer and Dance.
I HAVE READ THIS RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, & SIGN IT FREELY & VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name of Participant: ________________________
Name of Parent or Guardian: _______________________
Signature of Parent of Guardian: ________________________________________
Street Address: __________________________________________
State: NSW Post code: ________
Home Phone: ________________
Mobile Phone: _____________________
Emergency Name & Contact: ________________________________________________________________
Medical History (Known allergies & conditions:__________________________________________________
Do you have, Ambulance cover?: Yes / No