Please fill out the information in the form provided below.
DO NOT SUBMIT THIS FORM BEOFRE READING THE BELOW.
SECTION MUST BE READ BY PARENT AND/OR GUARDIAN
BEFORE REGISTRATION IS ACCEPTED. CHECK THE BOX ABOVE TO CONFIRM.
I give consent for photos/videotapes of myself/my children involved in Imani activities/programs to be used for promotional purposes.
Hold Harmless/Release Statement
I hereby give permission to Imani Edu-Tainers African Dance Company (IEADC) to transport the child named above off the site property for the purpose of medical care or program activities as deemed appropriate by the Director. In the event I cannot be reached in an emergency, I give permission to the physician selected by the program director to hospitalize, secure proper treatment for, and to order injection, anesthetic or surgery for the child named above. I understand that IEADC does not provide accident/medical insurance for the child named above. Medical bills, including prescription drugs, will be the responsibility of the parent or guardian named below.
Rules for participants are the same for everyone without regard to race, color, national origin, gender or disability. I understand that all participants will be treated as individuals and respect will be shown for a range of abilities and behaviors. I agree that IEADC reserves the right to dismiss a child from activities whose special needs they are not able to provide for or whose conduct is not in the best interest of the activity community. I will notify the director if my child has any serious restrictions related to his/her participation in this program.
As a condition of participation in or attending any IEADC activities, or any event whatsoever sponsored by or affiliated with Imani, participant/parent releases all claims and holds IEADC harmless from any and all liabilities, damages, expenses, cost, claims and causes of action that the participant/parent may have or claim to have now or in the future against IEADC, and its employees, officers, directors, committee members, representatives, affiliates and volunteers arising from or connected with the participantís participation IEADC, or participation in or attendance at (including travel to and from) any IEADC Event(s) during any time of the participation in IEADC.
Imani Edu-Tainers African Dance Company has my permission to use photographs taken of my child while at rite activities for promotional purposes.
We or I (Parents/Guardians) have read and agree to all the conditions of this registration.
THE ABOVE CHECK BOX MUST BE CHECKED BY PARENT AND/OR GUARDIAN BEFORE REGISTRATION IS ACCEPTED.
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