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Authorization, Waiver and Release

New York City Dance Alliance Authorization, Waiver and Release 

*Must be completed by each registered teacher and dancer and/or their parent/guardian prior to event participation. 

In order to induce New York City Dance Alliance Inc., and its affiliates, successors and assigns, including, but not limited to, Onstage New York Inc. and New York City Dance Alliance Foundation, Inc.  (collectively referred to as “NYCDA”) to register Participant in any and all Events which includes, but may not be limited to performing on stage, dance classes, rehearsals, or any other activity organized by NYCDA (collectively the “Events”), I, as Participant, or as the parent or legal guardian of Participant if he or she is a minor (“Minor Participant”), hereby acknowledge, accept and represent the following:

  1. Participant, and the parent or legal guardian of the Minor Participant, on their own behalf and on behalf of Participant, hereby waives and releases all claims, liabilities, actions, damages, costs or expenses of any nature whatsoever for injuries the Participant might sustain, known or unknown, arising out of the Events or its related activities, now or always in the future. Participant, and the parent or legal guardian of the Minor Participant, attests to carrying insurance coverage, should Participant require medical attention while attending NYCDA. The Participant, and the parent or legal guardian of the Minor Participant, agrees to indemnify and hold harmless NYCDA or any individual identified as associated with the organization of the Events, from and against any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, known or unknown, incurred by NYCDA and arising out of, or in any way related, directly or indirectly, to the Participant’s attendance at the Events.
  2. Participant, and the parent or legal guardian of the Minor Participant, acknowledges and agrees that participating in the Events includes strenuous physical activity and involves foreseeable risks of serious injury (including paralysis and even death) with or without the negligence of others and that Participant, and the parent or legal guardian of the Minor Participant, acknowledges that Participant is assuming the risk of such injury or illness by participating in the Events.  In the event of such injury or illness, Participant and the parent or legal guardian of the Minor Participant, authorizes NYCDA to obtain necessary medical treatment for him or her and hereby releases and holds harmless NYCDA in the exercises of this authority. Participant, and the parent or legal guardian of the Minor Participant, further acknowledges and understands that Participant will be responsible for any and all medical and related bills that may be incurred on Participant’s behalf for any illnesses or injury that Participant may sustain during the Events and while traveling to and from the site for the Events.
  3. Participant, and the parent or legal guardian of the Minor Participant, understands that NYCDA produces promotional material relating to its programs from time to time. Participant, and the parent or legal guardian of the Minor Participant, understands that as a participant and/or spectator of the Events that Participant may be included in video or photographs taken during the Events. Therefore, without reservation or limitations, Participant, and the parent or legal guardian of the Minor Participant, hereby assigns, transfers and grants to NYCDA, its successors, assigns, licensees, sponsors, any television networks, and all other commercial exhibitors, the exclusive right to photograph and/or video Participant and utilize such videos and photographs and my name, face, likeness, voice and appearance as a part of the Events, in any publicity, promotional publications, advertising and promoting the Events or in advertising and promoting similar future Events, which may include NYCDA’s website, social media, newspaper ads, bulletin boards, newsletters, programs, brochures, public broadcasting releases, etc. Participant further understands that neither NYCDA nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.

Participant, and the parent or legal guardian of the Minor Participant, hereby warrants that he or she has read this Authorization, Waiver and Release in its entirety and fully understand it contents. Participant, and the parent or legal guardian of the Minor Participant, is aware that this Authorization, Waiver and Release releases NYCDA from all Liability, contains an acknowledgement of Participant’s voluntary and knowing assumption of the risk of injury or illness, authorization for Medical Treatment, and an appearance authorization. Participant, and the parent or legal guardian of the Minor Participant, further acknowledge that Participant has signed this document voluntarily and that nothing in this Authorization, Waiver and Release constitutes a guarantee that the Events will occur. 

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Participant's Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email
Check to receive information, news, and updates by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Studio

Studio Name (Or "Independent" if attending without a studio) *
Studio State*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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