Music in Motion Dance Studio

Off-Campus Activities Permission, Assumption of Risk, and Acknowledgment

Studio means Dance Directions Inc (dba Music in Motion Dance Studio and Children’s Dance Theatre), and their officers, directors, employees, independent contractors, instructors, assistants, volunteers, agents, the Music in Motion Parent Booster Club and its officers/volunteers, event hosts, sponsors, and the owners/lessors of any premises used.

Season Covered: August 1, 2025 to July 31, 2026

Activities Covered (non-exhaustive): community performances, spirit nights and fundraisers, parades, car washes, sports game halftime/arena events, conventions and expo shows, nursing-home/assisted-living visits, festivals, competitions, informal social events such as pool parties or picnics, and travel to/from these activities.

Guardian/Parent First Name

Address

Street Address

City

State

Country

Postal code

Guardian/Parent Last Name

Minors Covered by this Authorization:

Student Name 1

Student 1 DOB

Student 2 Name

Student 2 DOB

Student 3 Name

Student 3 DOB

Assumption of Risk & Health

I understand dance, performance, travel, and related activities involve inherent risks, including but not limited to trips/falls, collisions, over-exertion, musculoskeletal injury, exposure to weather, road travel incidents, property loss/damage, and potential exposure to communicable illness. I confirm my child(ren) are physically able to participate or I have disclosed relevant conditions above. I accept and assume all inherent risks on behalf of my child(ren).

Communicable Illness Acknowledgment

Participation may include exposure to infectious diseases (e.g., cold/flu, RSV, COVID-19). Policies and personal discipline may reduce risk, but the risk of serious illness exists. I knowingly assume these risks on behalf of my child(ren).

Code of Conduct

My child(ren) will follow Studio and venue rules, instructions of staff/volunteers, and applicable laws. I understand participation can be limited or ended for unsafe or disruptive behavior without refund.

Personal Property

I understand my child(ren) are responsible for their personal items. The Studio is not responsible for lost, stolen, or damaged belongings.

Transportation & Car-pooling Permissions:

Select Yes or No for each category. If no selection is made, the default is No.

A. Ride with another child’s parent/guardian (21+, valid license/insurance):

Yes

No

With approved parent of my choice

B. Ride with licensed student driver under age 18 (where lawful; parent assumes seat-belt/booster compliance responsibility):

Yes

No

With approved student driver of my choice

C. Ride with Studio staff/instructors/contractors/volunteers (21+, valid license/insurance):

Yes

No

With approved instructor/staff member of my choice.

D. My child may self-transport if licensed/authorized by law and by me (high-school age only):

Yes

No

Not applicable

Car-seat/booster compliance:

I will provide any legally required car-seat/booster for my child and accept responsibility for proper use. I understand transportation may be in personal vehicles.

Per-Child Exceptions: If any permissions above differ per child, list child’s name and allowed options here:

Water/Pool & Similar Recreational Activities:

For informal social events that may include swimming/water play where a certified lifeguard may or may not be on duty:

Permission to participate in water activities

Yes

No

By event, with my express permission.

Swim ability

Non-Swimmer

Beginner

Confident

Life jacket required at all times

Yes

No

Medical Authorization

If, in the judgment of the Studio or its representatives, my child(ren) need emergency medical/dental care, I authorize them to arrange or consent to treatment and transport. I accept financial responsibility for resulting costs. I understand reasonable efforts will be made to contact me first if circumstances allow. Please complete the optional information below:

Physician / Clinic

Physician / Clinic Phone Number:

Insurance Policy

Insurance Policy Group / Number

Acknowledgment, Indemnification & Allocation of Responsibility

To the fullest extent permitted by applicable law, I (1) acknowledge and assume the inherent risks described herein; (2) agree to be responsible for my child(ren)’s compliance with rules and lawful instructions; and (3) agree to indemnify and hold harmless the Studio and Releasees from claims, demands, or causes of action brought by or on behalf of third parties to the extent caused by my child(ren)’s violation of rules/laws or misuse of property.

This document is not intended to waive claims for gross negligence, willful misconduct, or any liability that cannot be waived by law, and any waiver or release is intended only to the extent permitted by applicable law.

Term, Revocation & Notices

This authorization remains effective for the Season listed above unless I revoke it in writing by email to [email protected]. Revocation does not affect prior authorized participation.

Governing Law & Venue

This agreement is governed by the laws of the Commonwealth of Virginia. Venue for any dispute will lie in the state courts located in Virginia Beach, Virginia (unless otherwise required by law).

Severability

If any provision is found unenforceable, the remaining provisions will continue in full force.

Signers Full Name

Permission Slip Signature

Clear

Signed Date