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SCHOOL NAME___________________________________________________________________________________________________________________________
LIABILITY RELEASE.
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I _________________________________, as parent or
legal guardian of ___________________________________________, a minor (hereinafter “Minor”, hereby grant the permission necessary to allow this minor to participate in the
above Event to be conducted by Varsity Spirit LLC (”Varsity Spirit”), d/b/a Universal Dance Association (”UDA”), d/b/a National Dance Alliance (”NDA”), d/b/a United Spirit Association
(”USA”), and/or Varsity/Intropa Tours. I, in my own behalf and on behalf of the Minor, further agree to release and to hold harmless Varsity Spirit, Varsity Spirit’s Corporate Sponsors (hereinaf-
ter “Sponsors”), the Hosting site, (hotel, parade organizations and other entity providing service while on this Event and on whose premises the Event will occur (hereinafter the “Location”) the
affiliates of Varsity Spirit and the Location, and the respective directors, officers, representatives, members, agents and employees of Varsity Spirit, Sponsors, the Location and their respective
affiliates (hereinafter collectively “Releasees”) from any and all liability for negligence or any other claim judgement, loss, liability, cost and expenses (including, without limitations, attorney’s
fees and costs) arising out of or connected with the Event, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that the Minor
may incur or sustain during the Event, all activities associated with the Event and while traveling to and from the site for the Event whether or not the Event actually occurs. I further expressly
agree to indemnify and hold harmless Releasees and Releasees’ heirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may
subsequently be brought by Minor or by any other persons on the account of damages of any character resulting to Minor in any way from the foregoing activities. I further agree to reimburse
and to make good to Releasees any loss, or costs Releasees may have to pay as a result of any such action, claim, or demand.
I, in my own behalf and on behalf of the Minor, hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I, in my own behalf and on behalf of the
Minor, am aware that this Liability Release releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my
own behalf and on behalf of the Minor, further acknowledge that nothing in this Liability Release constitutes a guarantee that the Event will occur. I, in my own behalf and on behalf of the
Minor, have signed this document voluntarily and of my own free will.
Signature of Parent of Legal Guardian
X
___________________________________________________________________________________ Date:____/____/____
MEDICAL RELEASE
. I, in my own behalf and on behalf of the Minor, acknowledge and agree that such participation subjects Minor to possibility of physical illness or injury (minimal,
serious, catastrophic, and/or death) and that I, in my own behalf and on behalf of the Minor, acknowledge that the Minor is assuming the risk of such illness or injury by participating in the
Event. In the event of such illness or injury, I authorize Varsity Spirit to obtain necessary medical treatment of the Minor and hereby, in my own behalf and on behalf of the Minor, release and
hold harmless Releasees in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on
behalf of the Minor for any illness or injury that the Minor may sustain during the Event and while traveling to and from the site for the Event whether of not the Event actually occurs.
APPEARANCE AGREEMENT
. I understand that Varsity Spirit, d/b/a Universal Dance Association (”UDA”), d/b/a National Dance Alliance (”NDA”), United Spirit Association
(”USA”) and Varsity/Intropa Tours from time to time produces promotional material relating to its programs. I understand that as a participant and/or a spectator at the Event that Minor may
be included in videotapes, photographs, DVD’s, Podcasts, and videocasts taken during the Event. Therefore, without reservation of limitations, I, in my own behalf and on behalf of the Minor,
hereby assign, transfer and grant to Varsity Spirit, d/b/a Universal Dance Association (”UDA”), d/b/a National Dance Alliance(”NDA”), United Spirit Association (”USA”) its successors,
assignees, licensees, sponsors, and television networks, and all other commercial exhibitors the exclusive right to photograph and/or videotape the Minor and to utilize such videotapes and
photographs and Minor’s name, face likeness, voice and appearance as a part of the Event, in advertising and promoting the Event or in advertising and promoting similar future events. I
further understand that neither Varsity Spirit nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.
DEBILITATING CONDITION CLAUSE
. To the best of my knowledge, the Minor (name)___________________________________________, does not have any medical
conditions or debilitating illnesses that would hinder, hamper, or prevent me from being a full participant on this trip. I understand that if before December 26, 2016 his/her medical situation
changes I will contact Mike Fultz - Tour Director at 1-800-238-0286 ext. 4329 and discuss the situation.
Signature of Parent of Legal Guardian
X
___________________________________________________________________________________ Date:____/____/____
INSURANCE
Insurance Company: ___________________________________________________________________________________________________________________
Insurance Company Address: _____________________________________________________________________________________________________________
Medical Insurance Policy Number: ________________________________________________________________________________________________________
I represent that any medication to which Minor is allergic or medications that Minor is currently taking are listed below. I agree that Minor shall bring medications which Minor is currently
taking with him/her to the Event and that he/she shall consume the prescribed dosage for such medications.
Medications (if any): __________________________________________________________________________________________________________________________
Allergic to (if any): ____________________________________________________________________________________________________________________________
I acknowledge that the Minor suffers from the following conditions: ____________________________________________________________________________________
Family Doctor: ______________________________________________________ Phone Number: (_______)________________________________________________
EMERGENCY INFORMATION
Name: ______________________________________________________________
Address: _____________________________________________________________
City, State, Zip: _______________________________________________________
Relationship: _________________________________________________________
Work#: (____)____________ Home#: (____)____________ Cell#: (____)________
I, in my own behalf and on behalf of the Minor, hereby warrant that I have read this LONDON TOUR Participant Release and Waiver Form in its entirety and fully understand its concerns. I, in
my own behalf and on behalf of the Minor, am aware that this Participant Release and Waiver Form releases Releasees from liability and contains an acknowledgement of my voluntary and
knowing assumption of the risk of injury or illness. I, in my own behalf and on behalf of the Minor, further acknowledge that nothing in this Participant Release and Waiver Form constitutes a
guarantee that the Event will occur. I, in my own behalf and on behalf of the Minor, have signed this document voluntarily and of my own free will.
Signature of Parent of Legal Guardian
X
_________________________________________________________________________________________________
Relationship to Minor: ________________________________________________ Minor Birthdate: ____/____/____
I, identified above as Minor, acknowledge that I have read this LONDON TOUR Release and Waiver Form.
Signature of Minor
X
_________________________________________________________________________ Date:____/____/____
Signature of Witness
X
________________________________________________________________________ Date:____/____/____
Witness Address: ____________________________________________________________________________
* Your return packet will include release/waiver forms for family and friends.
LONDON TOUR RELEASE/WAIVER FORM
DECEMBER 26, 2016 - JANUARY 2, 2017
Name: ________________________________________________________________
Address: _______________________________________________________________
City, State, Zip: _________________________________________________________
Relationship: ___________________________________________________________
Work#: (____)____________ Home#: (____)____________ Cell#: (____)__________