MDT&S Release Form

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MDT&S Release Form

Please complete this form prior to the dancer attending class at MDT&S.

Name (dancer name if under 18) *

Email (of person filling out this form) *

Contact Number (of person filling out this form) *

Emergency Contact Name: *

Emergency Contact Phone Number *

Which MDT&S division is the dancer participating in? *

Young Children's Division / Boys Division

Performing Arts Division

Adult Open Division (including Fundamentals classes)

Please read carefully and date the following:

Photography & Videography Release:
I hereby consent to have my or my child/ward’s likeness published in photographs, films or other digital media captured by Minnesota Dance Theatre & School for educational, promotional, and advertising purposes.

I acknowledge that since my or my child's participation in all the above produced by MDT&S is voluntary, I will receive no financial compensation. I further agree that my or my child’s participation in any of the above mentioned produced by MDT&S confers upon me no rights of ownership whatsoever.

I agree to release and forever discharge MDT&S, its members, officials, agents, and employees from any and all claims, demands, actions, complaints, suits or other forms of liability that shall arise or be caused by the use of my child/ward in all media now known or hereafter devised.

Release and Indemnification:
Minnesota Dance Theatre & School (MDT&S) and its employees are not liable for injuries sustained or illnesses contracted by the student while attending the School.

YYYY

Acknowledgement: *

I have read the above and agree.

Electronic Signature (of person filling out this form) *

Printed name (if different than dancer)

Submit

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