PHOTO/FACEBOOK & MEDICAL STATEMENT FORM

All Star Dance & Performance Centre

Unit 10/15 Carbon Court Osborne Park Western Australia 6017

http://www.allstardance.com.au

Student Record

(Confidential Information)

PHOTO/FACEBOOK INFORMATION

 

I as parent/guardian of ________________________________(students name) allow “All Star Dance & Performance Centre” to use photos and video footage of your child on our Closed Facebook Page and for promotional and advertising purposes.

 

MEDICAL INFORMATION

 

Please read carefully prior to signing

This is a statement in which you are informed of some potential risks involved in dance associated training and of the conduct required of you during lessons. Your signature on this statement is required for you to participate in the curriculum offered by All Star Dance & Performance Centre located at Unit 10/15 Carbon Court Osborne Park Western Australia.

Read and discuss this statement prior to signing it.  You must complete this Medical Statement, which includes the medical-history section, to enrol in any All Star training program.

Activities related to dance training may be demanding.  When performed correctly, applying correct techniques, it is very safe.  When established safety procedures are not followed, however, there are risks.

To perform the skills required safely, you must not be extremely overweight or out of condition.  The activities related to dance may be strenuous under certain conditions.  Your respiratory and circulatory systems must be in good health.  All body air spaces must be normal and healthy.  A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem or condition, or who is under the influence of alcohol or drugs should not participate on All Star Dance Lessons.  If taking medication consult the teacher before participating in dance activities. 

If you have any additional questions regarding this Medical Statement or the Medical History Section, review them with your teacher and or Parent/Guardian before signing this form.

 

Does your child suffer from any allergy or health condition YES/NO if your answer is yes please give full details below.

 

 

 

 

 

 

I __________________________________________ authorize for a ambulance to be called in case of an emergency, all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

 

The information I have provided about my medical history is accurate to the best of my knowledge.

 

 

__________________________________

(Signature of Participant / Student or Parent/Guardian)

__________________________________

(Date)

 

 

 

 

 

 

AFFIRMATION AND LIABILITY RELEASE FORM

All Star Dance & Performance Centre Unit 10/15 Carbon Court Osborne Park Western Australia 6017

http://www.allstardance.com.au

 

(Please read carefully prior to signing)

I,_________________________________

(Student Name)

hereby affirm that I have been well advised and thoroughly informed of the inherent hazards and risks of dance and associated training.

Further, I understand that acrobatic dance training involves certain risks, and injuries may occur that require medical treatment, and nonetheless agree to proceed with such training.

I hereby personally assume all risk in connection with said course for any harm, injury, or damage that may befall me as a result of my participation in the course, whether foreseen or unforeseen, and I still wish to proceed with the course(s).

 

I understand and agree that neither the teaching staff employed by All Star Dance & Performance Centre; nor the All Star Dance & Performance Centre located at Unit 10/15 Carbon Court Osborne Park Western Australia may be held liable in any way for any occurrence in connection with the classes that may result in injury, death, or other damages to me or my family, heirs, or assigns; and in consideration of being allowed to participate on the course(s), I hereby personally assume all risks in connection with said course(s), for any harm, injury or damage

 

that may befall me while I am enrolled as a participant/student of dance, including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said activity and persons from any claim by me, or my family, estate, heirs, or assigns; arising out of my enrolment and participation in the course(s).

 

I further state that I am of lawful age[1] and legally consent to sign this affirmation and release; and that I understand the terms herein are contractual and not a mere recital; and that I have signed this document of my own free act.

 

It is the intention of

____________________________

(Student Name)

by this instrument to exempt and release the teaching staff employed by All Star Dance & Performance Centre and the All Star Dance & Performance Centre located at Unit 10/15 Carbon Court Osborne Park Western Australia, from all liability whatsoever for personal injury, property damage or wrongful death caused by negligence.

 

 

 

I HAVE FULLY INFORMED MYSELF TO THE CONTENTS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE I SIGNED IT.

 

__________________________________

(Signature of Participant / Student or Parent/Guardian)

__________________________________

(Date)

 

 

 

 

 

[1]Where a student is not of lawful age, the parent or guardian must consent to and sign this form prior to the student participating in any dance related activities.

More found over on our social pages @allstardanceandperformance on instagram and facebook

Website by Studio Blizzard