Agreement
Dance Movement Academy and any of the instructors or volunteers acting with the permission of Dance Movement Academy and its director Dircelia Rodin recognize our obligation to make our students and their parents, or any participant involved in our program, aware of the risks and hazards associated with dance. These risks and hazards may include the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with participation in dance activities.
Parents should make their child/children aware of the possibility of injury and encourage their child/children to follow all the safety rules and to follow teachers’ instruction.
I, ___________________________parent or guardian of ________________________ the undersigned, hereby waive all responsibilities from Dance Movement Academy, any of the instructors, employees or volunteers acting with the permission of Dance Movement Academy at Hickam AFB Community Center and its director Dircelia Rodin, from all liabilities arising from property damage and bodily injury which may be sustained during participation in any of the classes, activities and events offered by Dance Movement Academy.
With the above in mind, and being fully aware of the risks and possibility of injury, I agree to participate or, I consent to have my child or children participate in the programs offered by Dance Movement Academy.
Furthermore, I authorize and give full consent to Dance Movement Academy to copyright and publish any photographs or video recordings in which the above named student, appears as a result of participation in any of these programs.
By signing this waiver, it is understood that I have had an opportunity to read this document and I understand and agree to be bound by its terms and conditions.

Signature of Parent or Guardian if student, or participant, is younger than 18 years old.

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Print your child’s name
______________________________ ______________________ __________ Printed Self/Parent/Guardian’s Name Signed                                                   Date