Ensemble Español Online Fusion Class Waiver
Please fill out ONE form for each participant. Gracias!
Participant's Name: *
Program Location: *
Do you feel prepared to commit yourself to this program for 10 weeks? *
Participants Parent/Guardian Name: *
Emergency Phone Number: *
Contact Email Address: *
I acknowledge that me and/or my child will be using online applications and/or social media sites in order to participate in these classes. *
Consent Waiver: I understand that participation in this recreational program involves the risk of injury. These injuries include collision with other dancers, falling to the ground, scratches, bruises, etc. By signing this form, I acknowledge all risks of injury and I am willing to assume responsibility should injury result from them. I also agree to follow all rules and regulations of the program and to follow reasonable instructions of the program instructors and supervisors of the program. By signing below, I agree for myself, and my heirs, assigns, executors and administrators, to waive any legal rights I may have to seek payment of any kind from this program and to release Ensemble Español, Northeastern Illinois University and their employees from liability for damages resulting from my or my child’s injuries. *
Photo Release: I grant permission for the image and likeness from the photograph and/or video/audio recording of my or my child’s testimonial about the Ensemble Español Spanish Dance Theater to be used in the documentation of their educational programming. I am aware that the photograph and/or video/audio recording of me or my child may be viewed by grant committees, government or corporate entities. I understand that the clip may be used for marketing purposes and/or archival. I agree to such uses of this photograph, and/or audio/video recording and I waive the right to any royalties/payments from the use of any photo, video, and audio recordings. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing, prior to signing, to Ensemble Español staff, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. *
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