Roxey Ballet Teen Arts Festival Hunterdon County Dance Choreography Adjudication

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Email *

Teen Choreographer Name *

Teen Choreographer Phone Number *

Teen Choreographer's School *

Title of Choreography to be Adjudicated *

Length of Work (in minutes) cannot exceed 4 minutes *

Number of Dancers performing *

Brief Description of the Work (including an special props or costume effects) *

Please choose your top 2 time slots for adjudication Sunday, June 5, 2022 at Music Mountain Theater. You will receive an email with your confirmed time slot. *

10:00am

10:20am

I will not be attending in person

Required

We, the Parents/Guardians of (dancer(s)) have read the Roxey Ballet Protocols https://www.roxeyballet.org/covid-19-protocols and agree to abide by necessary face covering, observing of distance, and waive and release any and all future claims against the Roxey Ballet Company and its employees and associates for any injury, illness, (communicable disease, influenza or Covid-19) or loss sustained out of participation in the Teen Arts Dance Choreography Adjudication activity held by the Roxey Ballet Company. I knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of others and assume full responsibility for my child's participation. WAIVER OF LIABILITY, MEDICAL RELEASE, AND INDEMNIFICATION AGREEMENT: I HEREBY VOLUNTARILY PERMIT MYSELF AND MY CHILD TO PARTICIPATE IN THIS ROXEY BALLET COMPANY PRODUCTION. I UNDERSTAND AND FULLY ACCEPT THAT THERE ARE RISKS INVOLVED IN DANCE, AND THAT ACCIDENTS, ILLNESS AND INJURIES ARE COMMON AND ARE ORDINARY OCCURRENCES OF DANCE. I HEREBY AGREE TO ASSUME ANY AND ALL RISKS OF INJURY OR DEATH, AND I VERIFY THIS STATEMENT BY COMPLETING THIS FORM.As consideration for being permitted by the Roxey Ballet Company to participate in these activities, I hereby release and hold harmless the Roxey Ballet Company, its staff, volunteers, designated coaches, and program officials and supervisors from all liability, and from all actions or claims that I or my child now or hereafter have for damage or injury to my child, or to any person or property, resulting from the negligence or other acts of any employees or volunteers in connection with my child's participation.I further agree that this waiver, release and assumption of risk is binding upon my signature to this Waiver. In case of a medical emergency, I hereby give permission to the Directors, Staff and Volunteers to order treatment for my child, including any necessary medical treatment and x-rays. I also hereby give permission to the Director, Staff and Volunteers to disclose the information contained on this form to medical personnel. I understand that an attempt will be made to reach me by phone when a diagnosis is completed. I agree to pay all medical, hospital, or other expenses, which12my child or I may incur as a result of such treatment. The Roxey Ballet Company does not disclose your nonpublic personal medical and financial information, except as required or permitted by law. The Roxey Ballet Company also does not provide any medical or other insurance protection or benefits for those who participate in performances, use facilities or engage in activities on or off premises.I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND THE ROXEY BALLET COMPANY AND AGREE TO IT ON MY OWN FREE WILL. *

Yes I have read the protocols and release of liability

I will be attending virtually

Please list the names of all dancer(s) participating in the choreography including yourself as choreographer *

If participating Virtually, please email the link to your choreography to roxeyoutreach@gmail.com. We thank you for your participation. We look forward to seeing your work and will be contacting you shortly to confirm your participation in the Teen Arts Festival Dance/Choreography Event. Please contact us at anytime for additional information at roxeyoutreach@gmail.com

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