SIGNATURE ALL STARZ Waiver/Release, Medical Release & Appearance Form 2020/2021

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PARTICIPANTS/GUARDIANS -- READ BEFORE SIGNING

In consideration of myself / my child, participating in any way at Signature All Starz (SAS) classes, training, events & activities, the undersigned acknowledges, & agrees that:

I, the undersigned Student (or parent or legal guardian if the Student is under 18 years of age), do hereby grant permission for my son/daughter to participate in any Signature All Starz classes, training, events or activities in 2020/2021.

I further acknowledge and understand and agree that by participating at SAS classes, training, events or activities 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 the SAS, its agents, contractors any person representing to consent and authorise any medical attention, treatment, surgery or administration of drugs by qualified and licensed medical personnel for my son/daughter, which may become necessary. I will meet all costs and expenses incurred by SAS or by myself in the administration of any medical treatment to me/my son/daughter during an SAS class, training, event or activity. I understand SAS will use its best endeavours to contact me and to keep me informed in the event of any illness or injury occurring that requires medical treatment as soon as is practicable.

I understand the SAS produces promotional material about its program. I understand that my son/daughter may be included in videotape or photography taken during classes, training, events and activities. I hereby grant the SAS, its successors, assignee's, licensees, sponsors, any television networks and all other commercial exhibitors the exclusive right to photograph and/or videotape my son/daughter and further to utilise my son/daughter's name, face, likeness, voice and appearance as part of classes, training, events or activities, and in advertising and promotion of Signature All Starz. If you do not wish to have their images used in publications, social media, web-advertising and promotions you must notify us, in writing.

I willingly agree to comply with the Signature All Starz terms & conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation, I will remove my child from the participation & bring such attention of the nearest official immediately;

Rules / Regulations

No smoking, consumption of alcoholic beverages or use of illegal drugs allowed.
The SAS reserve the right to discipline any participant for unruly behaviour or for conduct unbecoming to Signature All Starz.
Participants must respect all venue and facility rules and regulations.
Participants must obey all rules and regulations set forth by Signature All Starz.

Email *

Student First Name *

Student Last Name *

Student Date of Birth *

YYYY

Student Email Address

Student Mobile Phone Number

Student Residential Address (please include suburb and postcode. *

Parent/ Guardian Full Name *

Parent/Guardian Email Address *

Parent/Guardian Residential Address please include suburb and postcode. *

Parent/Guardian Mobile Phone Number *

Student Medical History *

Student Emergency Contact Name and Phone Number

Is the Student Covered by Health Insurance? *

Yes

If yes which fund?

Does the Student have Ambulance Cover? *

Yes

Date filling in this form *

YYYY

I HAVE READ THIS RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, & SIGN IT FREELY & VOLUNTARILY WITHOUT ANY INDUCEMENT. *

Yes

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A copy of your responses will be emailed to the address you provided.

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