Participant's Name (Friend) *

First Name

Last Name

Parent/Guardian's Name (Participant) *

First Name

Last Name

Parent/Guardian's Phone *

(###)

###

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Student's Birthday *

MM

DD

YYYY

Center Stage Student's Name *

First Name

Last Name

I, the undersigned parent or guardian, do hereby grant permission for my daughter/son to participate in any activities at Center Stage Dance and Theatre School Incorporated. In consideration of participating in the Center Stage Dance and Theatre School Incorporated, I represent that understand the nature of this Activity and that my daughter/son is qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, my daughter/son will immediately discontinue participation in the Activity. I hereby release, discharge and covenant not to sue Center Stage Dance and Theatre School Incorporated, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and leasers’ of premises on which the Activity takes place, (each considered one of the “RELEASES” herein) from all liability, claims, demands, losses or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement of assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

I Agree.