Release and Authorization Form
I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release Sarah Parmer individually and Studio92 and its staff from any and all claims or damages of any kind arising out of my child's participation in the exercise and/or dance program of Studio92. I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program, I, the undersigned, do hereby authorize Sarah Parmer or her designated agents (being teachers or administrators employed by Studio92) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services, I understand that I am responsible for any medical expenses and that the absence of health insurance does not make Studio92 responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below.
