Release/Authorization

By enrolling my child/myself in classes at Dance Arts Academy, I hereby assume responsibility for injuries caused when regulations at the Academy are ignored. These regulations include, but are not limited to, using the studio without supervision, misusing the equipment, participating in class without proper footwear and disobeying instructions. I grant my child or ward permission to participate in Dance Arts Academy's 2009/2010 season. I hear by release and discharge Dance Arts Academy, it's agents, employees and officers, from all claims, demands, actions, judgments and executions with the undersigned heirs, executors, administrators, or assigns may have claim or claim to against Dance Arts Academy, it's successors, or assigns for all personal injuries caused by, or arising from, the above described actvities or activities related thereto.

Further, I grant Dance Arts Academy, it's agents and employees permission to authorize any emergency medical treatment that may be required for my child or ward during the 2009/2010 season. My medical insurance is offered through

___________________________________ (Insurance Company Name)

___________________________________(Policy Number)

I, the undersigned, have read this release/authorization and understand all of it's terms. I execute it voluntarily and with full knowledge of it's significance. I have executed this release/authorization on the day and year stated below.

Signature of Parent or Guardian ___________________________________ Date ________________