On behalf of myself or the child named below (the “Student”), I, the undersigned, hereby authorize Lonestar Dance Center LLC, a Texas limited liability company, its agents, representatives, and employees (collectively, the “Company”) to administer simple first aid to the Student in the event of minor injuries, and understand that family members or doctors will be called when in the discretion of the Company it is deemed necessary. If I cannot make arrangements for emergency medical attention at the time of serious illness or injury of the Student, I hereby authorize the Company to take any action as necessary for the Student’s well-being, including, but not limited to, transporting the Student to a nearby hospital, in the discretion of the Company. I further agree to be financially responsible for any medical services provided to the Student. I am aware that dancing, and the exercises associated with it, place unusual stresses on the body, and carry with them the risk of physical injury. On behalf of myself or my child (the Student), I hereby assume all risks and agree that the Company shall not be liable in any way for any injuries sustained during attendance at Lonestar Dance Center or any of its related functions. I AGREE THAT THE COMPANY SHALL NOT BE LIABLE FOR ANY DAMAGES, CLAIMS, OR COMPENSATION OF WHATEVER NATURE (INCLUDING LIABILITY FOR NEGLIGENCE, STRICT LIABILITY, OR OTHERWISE) THAT MAY ARISE IN THE NAME OF OR FOR THE BENEFIT OF THE STUDENT AND/OR ANY OTHER PERSON AS A RESULT OF PERSONAL INJURY WHILE ON THE PREMISES OF THE COMPANY OR OTHERWISE IN THE CARE OF THE COMPANY, INCLUDING ANY SUCH INJURIES SUSTAINED WHILE THE STUDENT IS BEING TRANSPORTED BY THE COMPANY. I HEREBY AGREE TO RELEASE, WAIVE, COVENANT NOT TO SUE, INDEMNIFY, AND HOLD HARMLESS THE COMPANY FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, JUDGMENTS, ACTIONS, EXECUTIONS, AND CAUSES OF ACTION WHATSOEVER. I UNDERSTAND THAT I AM WAIVING MY RIGHT TO TAKE LEGAL ACTION, INCLUDING FILING A LAWSUIT FOR INJURIES TO MYSELF AND/OR MY CHILD (THE STUDENT).

On behalf of myself or my child the Student, I further hereby grant the Company the absolute right and permission to take and use photographs and/or videos of the Student during attendance at the Lonestar Dance Center or any of its related functions. I understand that the
photograph(s) and/or video(s) may be used in a publication, print ad, direct mailing, electronic media (e.g., the internet, presentations, etc.), and/or other form of promotion. I release the Company, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I and/or the Student may have in connection with such use(s). Neither I nor the Student will make any monetary or other claim against the Company for the use of any such photograph(s) and/or video(s). I acknowledge and agree that the execution and delivery of this instrument to the Company is a condition precedent and a material inducement to the Company to permit the Student to use the Lonestar Dance Center and/ or participate in any of the Company’s related functions, without which the Company would not have agreed to permit such use and/or participation. By signing below, I hereby represent and warrant that I am the parent or legal guardian of the Student and that I have complete capacity and authority to sign this instrument and approve the agreements set forth herein on behalf of myself and the Student.

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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.
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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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