Medical Authorization & Liability Release

A copy of this form must be completed by each participant and turned in prior to the camp or event.
If you do not have this form on record prior to the camp or event, you will NOT be allowed to participate.

I. I, the undersigned parent or guardian, do hereby grant permission for my son/daughter, and hereinafter shall be referred to as "participant," to participate in any HTEDance & Spirit Group, Inc., hereinafter referred to as “HTEDance“, event or camp. In order that the participant may receive the necessary medical treatment, in the event of an injury or illness, I hereby hold HTEDance and its representatives harmless in the exercise of this authority.

II. I further acknowledge, understand and agree that in taking part in this clinic, camp or event, there is a possibility of physical illness or injury (minimal, serious or catastrophic) and that participant is assuming the risk of such illness or injury by participating. I agree to accept responsibility for my child, his/her safety and welfare during the course of this event or camp.

III. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, Influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

IV. I further agree to hold harmless HTEDance, including its principals, directors, officers, staff and employees which conduct the event or camp, for and/or from any illness or injury incurred by participant during the course of said camp/clinic or special event.

V. Finally, we agree not to pursue HTEDance, its principals, instructors, associates or affiliates legally, in the event that these issues do come to pass.

Student/Participant First Name *

Student/Participant Last Name *

Birthday * +

Parent/Guardian First Name

Parent/Guardian Last Name

Street Address *

City *

State *

Zip Code *

Participant/Parent/Guardian Cell Phone Number *

Participant/Parent/Guardian Email Address *

Please indicate the type of event your child is attending: *

School Name *

Please list below any medication which participant is currently taking. If participant is under medication, please check to make sure he/she brings his/her medication and that he/she takes the prescribed dosage.

Please list below food allergies to which participant is allergic to.

Parent/Guardian Signature. Please sign on the line using your mouse or finger. *

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