Page 1 of 1

UNIVERSAL CONSERVATORY OF BALLET - PARTICIPANT WAIVER, RELEASE OF LIABILITY & MEDIA CONSENT

Participant/Dancer Information

Participant Full Name

Date of Birth

Parent/Guardian Full Name

Email

Phone Number

ASSUMPTION OF RISK & RELEASE OF LIABILITY

I understand that participation in ballet, dance, conditioning, stretching, rehearsals, performances, auditions, workshops, and other physical activities involves inherent risks, including but not limited to falls, collisions, muscle strains, sprains, fractures, and other injuries.

I voluntarily choose to participate, or authorize my minor child to participate, in activities offered by Universal Conservatory of Ballet, operated by Dance Channel TV, Inc., and acknowledge and accept the risks normally associated with such activities.

To the fullest extent permitted by California law, I release and hold harmless Universal Conservatory of Ballet, Dance Channel TV, Inc., and their owners, directors, instructors, employees, contractors, volunteers, agents, and representatives from claims arising from the ordinary risks of participation, except to the extent liability cannot legally be waived.

I have read, understand, and agree to the Assumption of Risk and Release of Liability above.

MEDICAL AUTHORIZATION

I certify that I, or my child, am physically able to participate in dance activities. I understand that it is my responsibility to inform UCB of any medical condition, injury, allergy, or physical limitation that may affect safe participation.

In the event of an emergency and if I cannot be reached, I authorize Universal Conservatory of Ballet representatives to obtain reasonable emergency medical care for me or my child. I understand that I am responsible for any resulting medical expenses.

I agree to the Medical Authorization above.

PHOTO & VIDEO RELEASE

Universal Conservatory of Ballet may photograph or record classes, rehearsals, performances, auditions, events, and other school activities.

Media Consent

A
B

ELECTRONIC ACKNOWLEDGMENT & SIGNATURE

I confirm that I have carefully read this waiver and understand its contents. I understand that by electronically signing below, I am agreeing to its terms voluntarily.

If signing for a participant under 18, I certify that I am the participant’s parent or legal guardian and have authority to provide this consent.

Participant Name

Parent/Guardian Name

Electronic Signature

Sign here

Date