Dobson High School

Consent, Acknowledgment of Risk, and Liability Release

DANCE CLINIC 

Student Name (Printed):                                                                                                          

Parent/Guardian Name (Printed):                                                                                             

Parent/Guardian Phone Number:                                                                                              

Dobson High School is hosting a Dobson Dance Company Dance Clinic on Friday, April 17, 2013, from 4-6 p.m. in the small gym.  There is a $5 fee for admission that must be paid to the bookstore, and the receipt must be returned to Mrs. Arnold prior to the Dance Clinic, or pay at the start of clinic.

The parent or guardian of Student must sign this consent, acknowledgement of risk, and liability waiver form for Student to be eligible to participate in the Dance Clinic.

Consent.  Parent consents to Student’s participation in the Dance Clinic.

Acknowledgement and Acceptance of Risk.  Parent and Student acknowledge that they are aware of the inherent hazards and risks associated with participation in the Dance Clinic and knowingly and willingly accept the risks of participation.

No Medical Coverage.   Parent and Student acknowledge and accept that Mesa Public Schools will not assume responsibility for, or provide medical insurance to cover, any injuries or other losses suffered by Student or Parent.

Release of Liability.  With these understandings, Parent and Student hereby agree to waive and release Mesa Public Schools and its employees and volunteers from any claim or liability arising from participation of Student in the Dance Clinic.

Signature of Parent/Guardian                                         Signature of Student

Date:                                                                              Date: