If so, please provide details below.
Waiver/Medical/Publicity Release - please read *
Please read the information below and then sign the agreement by typing your name in the box below:
LIABILITY AND ASSUMPTION OF RISK I understand that my child will be attending Creative Groove Studio classes at Mile Square Theatre at 1400 Clinton Street) at his, her or my own risk and I will not hold the officers, directors, independent contractors, volunteers, or employees of Creative Groove Studio or Mile Square Theatre responsible for any injuries or damages received by the aforementioned student. I acknowledge my acceptance of this Assumption of Risk by agreeing to and allowing my child to participate in such class.
MEDICAL EMERGENCIES I hereby authorize the employees of Creative Groove Studio and/or Mile Square Theatre, an identified additional parent/guardian on the registration form, or the identified Emergency Contact to act as my agent and to consent to medical, surgical, or dental examination and/or treatment that may be necessary. I hereby authorize Creative Groove Studio's employees and/or Mile Square Theatre's employees to perform any acts which may be necessary or property to provide emergency health care of my child in the event that the parent/guardian and/or Emergency Contact cannot be reached, including consent to and authorization of medical procedures by qualified, licensed physicians, dentists, hospital or emergency medical personnel, as they, in the exercise of their profession and in their sole discretion, may deem necessary. I understand that I am responsible for all costs and expenses of such medial treatment.
PUBLICITY AND MEDIA RELEASE I understand that photos of students taken during classes may be used in promotional materials and public relations programs created by Creative Groove Studio (CGS). I hereby authorize CGS to record the student's picture and voice in photographs, films, and tapes; to edit these recordings at its discretion; and to incorporate these recordings into videos used on CGS's website or social media pages. CGS is permitted to use these materials for publicity, advertising, and sales promotions. There will be NO identifying information included if photos or videos of your child are used. I further acknowledge that no promises of compensation has been made by CGS for said use.