Student Movement Show Form

STUDENT MOVEMENT SHOW FORM

Participant Information

Student Name:

Date of Birth:    Student ID:    Grade / Program:

Parent / Guardian Information (if participant is a minor)

Performance & Rehearsal Details

Role / Position:    Rehearsal Start Date:    Performance Date:

I acknowledge my obligation to attend scheduled rehearsals and to comply with instructor directions. I understand failure to attend or comply may result in removal from the program or performance.

Transportation

School-provided transportation to off-site rehearsals and performance venues is:   Consent Do not consent

If student will be transported by parent/guardian or third party, provide name and relationship:

Medical Information & Authorization

Relationship:    Phone:

Primary Care Physician:    Phone:

Insurance Carrier:    Policy / Group #:

In the event of an emergency where urgent medical care is required, and reasonable attempts to contact parent/guardian have been unsuccessful, I authorize designated school personnel or instructors to consent to emergency medical treatment for the student, including transportation to a medical facility. I understand I am responsible for related expenses and agree to release and indemnify the school and representatives as set forth below.

Photo, Video, and Media Release

I hereby authorize the school and its authorized representatives to photograph, record, and/or otherwise document the student's participation in rehearsals and performances. I grant permission for the use of such images or recordings for educational, promotional, or archival purposes, including print and electronic distribution, subject to reasonable editorial control by the school.

Consent to media use Do not consent to media use

Code of Conduct, Assumption of Risk, Release and Indemnity

The student agrees to comply with all rules, directions, and safety protocols established by the school, instructors, and venue staff. Students and parents/guardians acknowledge that participation in movement-related activities involves inherent risks, including but not limited to slips, trips, falls, musculoskeletal injuries, and other physical injury.

By signing this form, the undersigned assumes all risk of injury and illness arising from participation, and releases the school district, school, its officers, employees, volunteers, contractors, and agents from any and all claims, damages, liabilities, costs, or causes of action arising out of participation, except to the extent caused by the intentional misconduct or gross negligence of the released parties. The undersigned further agrees to indemnify and hold harmless the released parties from any third-party claims relating to the student's conduct.

This release and indemnity is binding on the undersigned and, where applicable, on the parents or legal guardians of the minor student.

Acknowledgment and Certification

I certify that the information provided on this form is true and complete to the best of my knowledge. I have read and understand the policies, medical authorization, media release, code of conduct, assumption of risk, release, and indemnification provisions contained herein, and I agree to be bound by them as a condition of participation.

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