Saturday, March 27, 2021 Elementary & Jr. High Team Match Waiver & Release Form Sponsored by – Danzinskule Education Foundation – 501c3 Non Profit

All parents & students must complete this form to allow the dancer to participate in the team match event.

I am a*

My team is a/an:*

Elementary Teams*

Select your team:

Junior High Teams*

Select your team:

Student Name*

First Last

Parent Name*

First Last

Parent Email*

Parent Phone*

(Required for potential COVID-19 contact tracing)

Student Phone

(Required for potential COVID-19 contact tracing)

Name*

First Last

Email*

Phone*

(Required for potential COVID-19 contact tracing)

Team Match Guidelines

By checking the boxes below, we agree to the following Team Match Guidelines:*

We understand the student will be selected to dance based on maximum classroom participation.
We understand class fees must be paid in order for the student to participate in the Team Match.
We understand the student must wear black and white syllabus clothing to the Team Match event. (Boys: black pants & white shirt. Girls: black skirt & black top.)
We understand the student must be willing to perform whichever dance the teacher assigns him/her to perform.
We understand the ballroom teacher will inform the student about required school transportation policies to the event.

By checking the boxes below, I agree to the following Team Match Guidelines:*

I understand the student will be selected to dance based on maximum classroom participation.
I understand class fees must be paid in order for the student to participate in the Team Match.
I understand the student must wear black and white syllabus clothing to the Team Match event. (Boys: black pants & white shirt. Girls: black skirt & black top.)
I understand the student must be willing to perform whichever dance the teacher assigns him/her to perform.
I understand the ballroom teacher will inform the student about required school transportation policies to the event.

COVID-19 Waiver

By checking the boxes below, we agree to the following COVID-19 Waiver:*

We understand that safety precautions such as required mask wearing, social distancing measures, and sanitizing procedures will be followed before event and between sessions.
We agree not to attend the Team Match if we are experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell within 14 days of the event or on the day of the event.
We acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that the student and spectators may be exposed to or infected by COVID-19 by attending this event and that such exposure or infection may result in personal injury, illness, permanent disability, and death.
We voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to the student or spectators (including, but not limited to, personal injury, disability or death) illness, damage, loss, claim, liability, expense, of any kind, that I or the student may experience or incur in connection with the student’s attendance at the event (“Claims”).
On my behalf, and on behalf of the student, we hereby release, covenant not to sue, discharge, or hold harmless American Heritage School or dănzinsküle Education Foundation, it’s employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs of expenses of any kind arising out of or relating thereto.
We understand and agree that this release includes any Claims based on the actions, omissions, or negligence of American Heritage School and dănzinsküle Education Foundation Team Match Event, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in any dănzinsküle Education Foundation Team Match event.
We understand that this release discharges dănzinsküle Education Foundation or American Heritage from any liability or claim that we, our heirs, or any personal representatives may have against dănzinsküle Education Foundation or American Heritage by attending the Jr. High Team Match event.
We agree that by attending the Jr. High team match event, myself and the student do so by our own choice and our own risk.

By checking the boxes below, we agree to the following COVID-19 Waiver:*

I understand that safety precautions such as required mask wearing, social distancing measures, and sanitizing procedures will be followed before event and between sessions.
I agree not to attend the Team Match if I am experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell within 14 days of the event or on the day of the event.
I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I and other spectators may be exposed to or infected by COVID-19 by attending this event and that such exposure or infection may result in personal injury, illness, permanent disability, and death.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or spectators (including, but not limited to, personal injury, disability or death) illness, damage, loss, claim, liability, expense, of any kind, that I may experience or incur in connection with attendance at the event (“Claims”).
On my behalf, I hereby release, covenant not to sue, discharge, or hold harmless American Heritage School or dănzinsküle Education Foundation, it’s employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs of expenses of any kind arising out of or relating thereto.
I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of American Heritage School and dănzinsküle Education Foundation Team Match Event, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in any dănzinsküle Education Foundation Team Match event.
I understand that this release discharges dănzinsküle Education Foundation or American Heritage from any liability or claim that I, my heirs, or any personal representatives may have against dănzinsküle Education Foundation or American Heritage by attending the Jr. High Team Match event.
I agree that by attending the Jr. High team match event, I do so by my own choice and my own risk.

Media Release

By checking the box below, we agree to the following Media Release:*

In the process of producing educational and promotional materials, we at dănzinsküle Education Foundation may require the use of video, live streaming, still image, and voice recordings of individuals involved in the production thereof. By signing this document, we grant dănzinsküle Education Foundation all rights to the dancer's likenesses, images, and recordings, including edited versions without payment of fees in perpetuity. We authorize the use of these media for any use deemed necessary for the proper function of dănzinsküle. The aforementioned media will be used solely for dănzinsküle productions and will not be shared with any other entity.

By checking the box below, I agree to the following Media Release:*

In the process of producing educational and promotional materials, we at dănzinsküle Education Foundation may require the use of video, live streaming, still image, and voice recordings of individuals involved in the production thereof. By signing this document, we grant dănzinsküle Education Foundation all rights to the dancer's likenesses, images, and recordings, including edited versions without payment of fees in perpetuity. We authorize the use of these media for any use deemed necessary for the proper function of dănzinsküle. The aforementioned media will be used solely for dănzinsküle productions and will not be shared with any other entity.

Electronic Signature

By signing our names below, we agree to all conditions of this waiver and release form.

Electronic Signature

By signing my name below, I agree to all conditions of this waiver and release form.

Student*

Date*

Parent*

Date*

Name*

Date*

Phone

This field is for validation purposes and should be left unchanged.