Enrolling now for Fall 2023
Authorization for Release and Use of Student Image
I hereby grant Dance Class Inc. the following irrevocable rights:
1. The right to use my name, photograph, picture, portrait, likeness, and voice
(hereinafter collectively known as image) in connection with its educational
materials or for any other legitimate purpose;
2. The right to use, reproduce, publish, exhibit, distribute, and transmit my image
individually or in conjunction with other images or printed matter in the production
of brochures, motion pictures, television tape, sound recordings, still photography,
CD-ROM, and other media;
3. The right to record, reproduce, amplify; and simulate my image and all sound effects produced;
4. The right to copyright, in its own name, works that contain my image; and
5. The right to assign the above-mentioned rights to third parties.
I hereby waive the right to inspect or approve my image or any finished materials that
incorporate my image. I understand and agree that I will receive no compensation, now or
in the future, in connection with the use of my image.
I hereby release and forever discharge Dance Class Inc. from any and all claims, demand,
rights, and causes of action of whatever kind that may arise from the use of my image,
including all claims for libel and invasion of privacy.
I understand that the acceptance of this release form by Dance Class Inc. shall not constitute a waiver, in whole or in part, sovereign immunity by said board, its members, officers, agents, and employees.
I understand that my right to access accommodations and services through Dance Class Inc. shall not be jeopardized in any way by a decision not to sign this release.
Signature _______________________________________ Date ________________
Name Printed ____________________________________
Waiver and Release
Dance students and employees of Dance Class, and if he or she is a minor, his/her parent or guardian expressly agrees that Dance Class, its owners and agents shall not be liable for any damages arising from personal injury sustained by the student, employee or his/her guest on or about the premises of Dance Class or any premises where a recital or show is being performed. He/she accepts full responsibility for any such injuries or damages which may occur to a student or employee, or guest in, on or about the premises of said dance studio and other sites and does hereby fully and forever release and discharge the studio, it owners, employees/agents from any and all claims, demand, damages, right of action or causes of action, present or future, whether the same is known or unknown, anticipated or unanticipated, resulting from or arising out of the use or intended use of the dance studio or the facilities and equipment thereof.
Student(s) / Employee Name
Student / Employee Signature
(Guardian if applicable)