Journey to Africa Youth Cast Application

Full Name (required)

Student Age

Parent/Guardian Email (required)

Parent/Guardian Name (required)

Your Telephone Number

Participation Waiver

Indicated in the space below are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release Dance Levels individually and Dance Levels and its staff, contractors, teachers, and any other associates from any and all claims or damages of any kind arising out of my child’s participation in the exercise and/or dance program of Dance Levels I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do hereby authorize Dance Levels or her designated agents (being teachers or administrators employed by Dance Levels) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make Dance Levels responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below.

Covid Release Waiver (please type full name below) *

We do our best to ensure all participants are safe. Participants will not be able to take class if they have any symptoms of COVID. All staff and students must wear a mask on campus. I release Dance Levels it’s instructors, independent contractors, 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 The Dance Levels. I hereby acknowledge that I am voluntarily assuming full responsibility for all risks of physical injury arising out of active participation in a dance class or other dance related activities. I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntary assume the risk that I and/or my children may be exposed to or infected by COVID-19 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 COVID-19 and other 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 The Dance Levels its instructors, independent contractors and all associates from liability for harm, injury or death pertaining to COVID-19 and other contagious diseases and viruses. I understand that there are NO refunds for registration fees, costume, recital fees or classes. I understand that if my dancers class gets cancelled due to weather, sickness, or any issues arising from COVID-19 there is no refund for these missed classes.

Do you accept the the terms to the above for Dance Levels Waiver & COVID Waiver?

yesno

Signature of Agreement. Please enter your full name
Please Enter Date As YYYY-MM-DD: Example 2021-02-20