Little Dreamers Registration Form
-Jazz or ballet slippers
RELEASE & WAIVER
PARTICIPANT LIABILITY WAIVER AND HOLD HARMLESS AGREEMENT
Please read this form carefully and be aware that by registering for and participating in this program(s) or by registering your minor child/ward for participation in this program(s), you will be waiving your rights and/or the rights of your minor child/ward to all claims for injuries you or your minor child/ward might sustain arising out of this program(s) and you will be required to indemnify, hold harmless and defend Activator Academy, Inc. CROYA, the City of Lake Forest, and the Village of Lake Bluff for any claims arising out of participation in said program(s).
Risk in Injury: “As a participant in the program, or as a parent or legal guardian of a participant un- der 18 years of age, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of injuries, including death, damages, or loss which I may sustain as a result of participating in any and all activities associated with this program.”
Waiver of Injury Claims: “I agree to waive and relinquish any and all claims I may have arising out of, connected with, or in any way associated with the activities of the program.”
Release from Liability: “I do hereby fully release and discharge, Activator Academy, Inc., CROYA, the City of Lake Forest and Village of Lake Bluff and its officers, agents and employees from any and all claims from injuries, including death, damage or loss which I or my minor child/ward may have or which may occur on account of participation in the program.”
Indemnity and Defense: “I further agree to indemnify, hold harmless and defend Activator Academy, Inc., CROYA, City of Lake Forest and Village of Lake Bluff and its officers, agents, and employees from any and all claims from injuries, including death, damages and losses sustained by me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the program.”
In the event of any emergency, I authorize Activator Academy, Inc. and/or CROYA to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed reasonable and necessary for my minor child’s immediate care and agree that I will be responsible for payment of any and all medical services rendered.
2) I also grant permission for Activator Music to use photographs and videos of my
child for promotion, marketing and advertising in print media and online for Activator Music Academy's website, and any other promotional sources. Last names will be excluded unless additional permission is granted.