Name of Dancer *

First Name

Last Name

Birthdate of Dancer *

MM

DD

YYYY

Waiver of Liability *

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN Ballet Beyond Borders LA August 2024, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I (or my child) am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my (or my child's) participation in this activity or event. I certify that I (or my child) am in good health and that I do not pose a health risk to the public. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I (or my child) may participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: I HEREBY WAIVE, RELEASE, AND DISCHARGE Ballet Beyond Borders and Rocky Mountain Ballet Theatre and all divisions thereof of any and all liability and responsibility for injuries, sickness, pandemics, accidents, natural disasters and/or acts of God incurred during participation in and/or instruction of camps, private lessons, or any activity I (or my child) may participate. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my (or my child's) death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Ballet Beyond Borders and Rocky Mountain Ballet Theatre and their employees, volunteers, or the activity or event holders, activity or event sponsors, activity or event volunteers. I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this waiver, release and registration form from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I CHECK THE BOX ON MY OWN FREE WILL.

Yes

Media Release *

I hereby grant Ballet Beyond Borders and Rocky Mountain Ballet Theatre the absolute and irrevocable right and permission, in respect of the photographs and/or video taken of me (or my child) alone or with others, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in conjunction therewith if Ballet Beyond Borders and Rocky Mountain Ballet Theatre so chooses. I hereby release and discharge Ballet Beyond Borders and Rocky Mountain Ballet Theatre from any and all claims and demands arising out of or in connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Ballet Beyond Borders and Rocky Mountain Ballet Theatre. Any photos I provide to Ballet Beyond Borders and Rocky Mountain Ballet Theatre I acknowledge that I have been given consent from the photographer to share.

Yes