Waiver To Be Completed by Guest Participant’s Parent or Guardian Current AFS Student who invited you First Name Last Name Class You are participating inGuest Student* First Last Age*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Would you like to receive text communications?*YesNoEmail Address* PARTICIPATION: I hereby give permission for the above-named student to participate in dance class(es) and performances at Angela Floyd School for the Dancer and acknowledge these classes involve physical, athletic and recreational activities of which I represent and warrant that the above-named student is physically and mentally capable of participating. CONSENT TO TREATMENT: In case of a medical emergency, I authorize Angela Floyd School for the Dancer on my behalf and at my account to contact “911” and take such measures and arrange for such medical and hospital treatment as needed for the health and well-being of the above-named student without the need for further consent or permission. For matters not involving a medical emergency, I understand that Angela Floyd School for the Dancer will attempt to notify the parents and/or emergency contacts listed on the above-named student’s registration form. WAIVER AND RELEASE OF LIABILITY: I, individually and on behalf of the above-named student acknowledge that the student will be participating in dance class(es) and/or performances at or through Angela Floyd School for the Dancer at his/her own risk. I fully understand and agree that by participating in the aforementioned dance class(es) or performances it is possible the student may suffer an accident or other physical injury. Accordingly, I, on my own behalf and on behalf of the above-named student, do hereby specifically and expressly release, discharge, hold harmless and agree to indemnify Angela Floyd School for the Dancer, its owners, directors, officers, employees, agents, assigns, and all volunteer personnel from any and all liability, damage, injury or illness, including all acts of active or passive negligence, to the student or his/her personal property during his/her participation in activities at or through Angela Floyd School for the Dancer. I, on my own behalf and behalf of the above-named student, further agree to indemnify and hold harmless Angela Floyd School for the Dancer for any claims brought by the student as a result of injuries sustained or damages sustained while engaging in activities at or through Angela Floyd School for the Dancer. I further give my permission for photographs, videos and /or audiotapes of myself and the participant (s) named below, to be used in print or broadcast media ad deemed appropriate for the promotion of any AFSD activities. Parent's Name* First Last Signature*Date* Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.