Medical, Transportation, Financial, & Social Media Release Forms

Medical Release

I request that in my absence the above-named participant may be admitted to any hospital or medical facility for

diagnosis and treatment. In my absence I request and authorize physicians, dentists, and staff, duly licensed as

Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses to perform any LIFE

SAVING diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above

participant. – No vaccines can be administered without Guardian Consent.

• (Participation requires agreement to all releases, If you do not agree, you may choose not to enroll. Checking “I Agree” confirms your voluntary consent.)

Waiver, Indemnity & Assumption of Risk Agreement

In consideration of Inspiration Dance Company (hereinafter “Dance”), affiliated with Inspiration Academy (hereinafter

“Academy”) permitting my child (hereinafter “Child”) to participate in physical activities including but not limited to

exercise, competitive sports/dance, recreational sports/dance, stretching, fitness training, conditioning and nutritional

instruction (collectively referred to as “Classes/Lessons/Competitions”), on behalf of myself, my heirs, personal

representatives, or assigns, I assume all risks and hereby release, waive, discharge, and covenant not to sue the Inspiration

Dance Company or Inspiration Academy, its employees, volunteers, agents and contractors, from liability from any and

all claims arising from or relating to my child’s participation in the Dance classes/lessons/Competitions. I understand that

the DANCE/ACADEMY services are not a substitute for professional medical advice or a medical examination. Prior to

permitting myself or my Child to participate in any DANCE/ACADEMY program, activity, or exercise, I will seek the

advice of a pediatrician or another health-care professional. I understand that exercise and physical activity provides

certain health benefits for children, but can also cause unknown health issues and therefore should be done in moderation.

I understand that equipment commonly associated with physical fitness/dance may be present at the site where the

classes/lessons take place, and that the presence of such equipment could result in an injury to myself or my Child. By

allowing myself or my Child to participate in the classes/lessons/competitions or any activity associated with the

DANCE/ACADEMY, I agree that the DANCE/ACADEMY shall not be liable for any direct, indirect, special,

consequential, or exemplary damages for any injury or harm to me or my Child incurred in or around the property where

exercise occurs. I agree to hold harmless and indemnify the DANCE/ACADEMY, its employees, volunteers, agents,

contractors and insurance carriers from all claims (whether initiated by me or by a third party) and to reimburse them for

any expenses incurred because of myself or my Child’s participation in the classes/lessons and other

DANCE/ACADEMY activities. I further agree to pay all expenses, including court costs and attorneys’ fees, incurred by

the DANCE/ACADEMY and the parties in investigating and defending a claim or suit resulting from myself or my

Child’s participation in DANCE/ACADEMY classes/lessons/competitions. I further expressly agree that the foregoing

waiver, indemnity and assumption of risk agreement is intended to be as broad and inclusive as is permitted by the laws of

Florida, and that if any portion thereof is held invalid, it is agreed that the balance shall continue in full legal force and

effect. I also agree that if legal action is brought, it must be brought in Manatee County, Florida. I have read and agree to

the terms of the policy.

Transportation Release

I hereby give Inspiration Dance Company permission to transport the participant to any event, activity, or

competition coordinated by Inspiration Dance Company and its affiliated parties/employees.

Financial Responsibility Form

I hereby acknowledge that Inspiration Dance Company/Inspiration Academy is not required to refund any

payments for any circumstance pertaining to classes/lessons/competitions. If a refund is approved, it is case by case

and only decided by Inspiration Dance Company.

Social Media Release Form

I consent for photographs and/or video images to be taken of me by INSPIRATION DANCE COMPANY, or a

representative. I understand the images may be used for marketing purposes (website, print, digital or

social media).

By consenting to photographs and/or video images I understand I will not be compensated from

any party. Although photographs and/or video images will be used without identifying

information such as name, I understand it is possible someone may recognize me.

I acknowledge that Inspiration Academy is affiliated/connected to Inspiration Dance Company. Some

video/images may be used by Inspiration academy via website, print, digital, social media, marketing and

advertising purposes. I further acknowledge that my participation is voluntary and agree that use of any

photographs and/or video images confers no rights of ownership or royalties whatsoever.

I hereby release INSPIRATION DANCE COMPANY/INSPIRATION ACADEMY, its employees, and any third

parties involved in the creation of or publication of educational or marketing materials, from liability for any

claims by me or any third party in connection with my participation.

By typing or signing my name below, I consent to using an electronic signature, which has the same legal effect

as a handwritten signature. I confirm understanding of all forms. If I wish to withdraw my consent for any of the

following forms; Medical Liability, Transportation, Financial, and/or Social Media, I may do so via written

request submitted to INSPIRATION DANCE COMPANY or by completion of a new form. This consent form

remains valid for the duration of the student’s enrollment unless withdrawn in writing.