Release Form
THIS RELEASE is executed on ______________________________________ (today’s date), by ______________________________(name) of __________________________________ (city, state) hereinafter referred to as “RELEASOR”, in consideration of being permitted to participate in the Antelope Valley Ballet, RELEASOR does himself/herself and personal representatives, heirs, and next-of-kin hereby release, waive, discharge and covenant not to sue the Board of Directors of the Antelope Valley Ballet, its agents and employees, hereinafter collectively referred to as “RELEASEES”, their heirs, administrators, executors and successors in interest, of and from, any and all liability to the RELEASOR, his/her personal representatives, assigns, heirs, and next of kin, for all loss, damage, action or right of action of whatsoever kind or nature, and any claim or demand therefore, either in law or in equity, on account of injury to the person and/or property whether known or unknown including death of the RELEASOR, whether caused by the negligence of RELEASEES, or otherwise while RELEASOR is participating in said dance company,
RELEASOR hereby assumes full responsibility for and risk of bodily injury, death or property damage due to negligence of RELEASEES or otherwise while participating in said dance company.
This release is part of the contract agreement between the parties hereto and the terms of this Release are contractual and not a mere recital.
RELEASOR further states that he/she has carefully read the foregoing Release and knows the contents thereof and signs this release as his/her own free and voluntary act.
IN WITNESS WHEREOF, RELEASOR has executed this Release at __________________________________________________________________________(your full home address) the day and year first above written.
_______________________________
(RELEASOR – or Parent’s signature)
Parent’s: please fill out the following if the dancers is under the age of 18.
I hereby certify that I am the parent and/or guardian of _________________________(dancer’s name) and that the above and foregoing matter has been fully explained to me and I, for and on behalf of ________________________________(dancer’s name), a minor, do hereby release all liability and covenant not to sue as set forth in the body of the RELEASE above, with the same force and effect as is executed by me.
PARENT’S NAME___________________________________________________________________
ADDRESS___________________________________________________________________________
CITY, STATE, ZIP__________________________________________ DATE__________________
IN CASE OF EMERGENCY CONTACT _________________________________________________
PHONE (________)_________________________
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