Name *
Phone *
Which section are you registering for? *
PARENT/GUARDIAN WAIVER AND INDEMNITY AGREEMENT I have read, understood and will comply with all guidelines, procedures, and policies put forth by Experience Arts School. In consideration of your accepting me, or my child, for participation at Experience Arts School, I hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages that I may have against the aforementioned organization and its agents, employees, representatives, successors and assigns for any and all injuries suffered by myself or my child that arise out of the aforementioned program, activity, sport, dance sponsored by the aforementioned organization. I warrant that I have the right to authorize the foregoing and do hereby agree to hold the aforementioned organization harmless of and from any and all liability of whatever nature which may arise out of or result from such participation. For the consideration stated above, I further agree that in the event that my child or I should make any claim against the aforementioned organization for damages arising out of the aforementioned program, activity, sport or dance, I will personally indemnify, defend, and hold harmless the organization and its agents, employees, and representatives, successors, and assigns against any and all loss and damage occasioned thereby, including attorney’s fees. I have read and understand this Agreement and have willingly placed my signature below as evidence of my acceptance of all conditions contained herein. VIDEO AND PHOTO RELEASE FOR EXPERIENCE ARTS SCHOOL MINISTRIES Subject(s), hereby grants to Experience Arts School Ministries the exclusive rights to use the video/photo(s) taken/supplied with Subject’s image(s) for the inclusion in any work produced by Experience Arts School Ministries. Subject acknowledges that the depiction of him/her in the video/photo(s) may be duplicated, altered, and distributed in any and all manner and media throughout the world in perpetuity. Subject(s) herby releases and discharges Experience Arts School Ministries, its employees, agents, licensees, successors, and assigns from any and all claim, demands or causes of actions that it may have or may have from now on and for libel, defamation, invasion of privacy or the right of publicity, infringement of copyright or trademark, of violation of any other right arising out of or relating to a utilization of the rights granted under this agreement. Subject(s) agrees that Experience Arts School Ministries shall have the unlimited right to vary, change, alter, modify, add to and/or delete from his/her depiction in the video/photo(s) and to rearrange and/or transpose his depiction, and to use a portion or portions of his/her depiction of character together with any other literary, dramatic, or other material of any kind. All rights, licenses and privileges herein granted to Experience Arts School Ministries are irrevocable and not subject to rescission, restraint or injunction under any circumstances. Nothing herein shall be construed to obligate Experience Arts School Ministries to produce, distribute or use any of the rights granted herein. This agreement shall be construed according to the laws of the State of Arizona applicable to agreements which are executed and fully performed within said State. This agreement contains the entire understanding of the parties relating to the subject matter, and this agreement cannot be changed except by written agreement executed by the party to be bound. I HAVE READ THE ABOVE PARENT/GUARDIAN WAIVER AND INDEMNITY AGREEMENT. I UNDERSTAND THAT AN ELECTRONIC SIGNATURE HAS THE SAME LEGAL EFFECT AND CAN BE ENFORCED IN THE SAME WAY AS A WRITTEN SIGNATURE.
I fully understand that Experience Arts School (hereinafter referred to as EAS) staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the EAS staff to render first aid to my child in the event of any kind of injury or illness, and if deemed necessary by the EAS staff to seek medical help, including transportation by an EAS staff member or its representatives, whether paid or volunteer, to any health care facility or hospital or the calling of an ambulance for said child should the EAS staff deem this to be necessary. I acknowledge that I am responsible for all reasonable charges in connection with the care and treatment rendered during this period and release EAS of any liability.I HAVE READ THE ABOVE AUTHORIZATION FOR EMERGENCY MEDICAL CARE FOR A MINOR. I UNDERSTAND THAT AN ELECTRONIC SIGNATURE HAS THE SAME LEGAL EFFECT AND CAN BE ENFORCED IN THE SAME WAY AS A WRITTEN SIGNATURE.
Jane Smith - Grandma
Emergency Contact Mobile # *
Emergency Contact Mobile #