Hurricane Harvey

Student Name *
Student Name
Parent/Guardian Name *
Parent/Guardian Name
Phone *
Phone
Terms *
I, on behalf of my child and myself, understand that risk of injury is inherent in any physical activity; I knowingly and voluntarily accept that risk. I, the undersigned, do herby authorize Schae Burley or her designated agents (being teachers or administrators employed by SB Dance Academy and Amarillo Performing Arts Center) to obtain medical treatment for my 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 SB Dance Academy or Amarillo Performing Arts Center 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. Parents, legal guardians of minor student, and students waive the right of any legal action for any injury sustained on studio property conducted by the student before, during, or after class. SB DANCE ACADEMY AND AMARILLO PERFORMING ARTS CENTER ARE NOT RESPONSIBLE FOR INJURY, LOSS, OR THEFT. I agree to abide by all rules, regulations, and policies of the studio. SB Dance Academy and Amarillo Performing Arts Center have my permission to use any class, competition, or other photos and videos which include the likeness of my child on their printed studio material, website, teaching purposes, etc.