ALL DANCE INTERNATIONAL

WAIVER AND RELEASE FORM

Every Participant must have a completed and signed form turned in prior to the first day of the event and/or competition to be
allowed to participate.

ALL DANCE INTERNATIONAL NEW DANCERS 2018

Location

Country Ecuador City Guayaquil State Guayas

Event days 02/03/2018; 03/03/2018; 04/03/2018

Participant’s Personal Information

_________________________________________________ _____/_____/_____

Last Name First Name Middle Name Date of Birth

______________ Gender: M / F

Age

______________________________________________________________________

Address City State Zip Code

_________________________________

Phone Number

Parent & Legal Guardian Information (If Participant is a Minor)

______________________________________________________________________

Parent/Guardian Name

_________________________________

Phone Number

__________________________________

Email Address

Studio Information

_______________________________________________________

Studio Name

______________________________________________________________________

Address City State Zip Code

_________________________________

Phone Number

__________________________________

Email Address

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IN CASE OF AN EMERGENCY

Primary contact: _____________________________

Relationship: ___________________

Address: ______________________________________________________________

Phone - Work: ________________________

Phone Number - Home: ________________________

Cellular: _______________________

EMERGENCY AND INSURANCE INFORMATION

Insurance Carrier_______________________ Policy Number ________________________

Policy Holder’s Name ______________________ Group Number: ______________________

Physician’s Name: _______________________Telephone Number:_____________________

Ingrese la siguiente información de ser aplicable :

a. Health Problems: ____________________________________________

b. Medications and Dosage: _______________________________________

c. Allergies: ___________________________________________________

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ASSUMPTION OF RISK AND RELEASE
I, ______________________________________ (Fill in Participant’s name or the name of Minor’s Parent or legal Guardian as
applicable) on my own behalf or as parent or legal guardian of ____________________________ (Fill in Minor’s name if
applicable) (hereinafter “Minor”) hereby express my intention to participate or grant the permission necessary to allow Minor to
participate in the competition (hereinafter “Event”) to be conducted by All Dance International . I, on my own behalf and/or on
behalf of the Minor, further agree to release, hold harmless and forever discharge All Dance International, the Hosting Site
(including but not limited to University, Theater, Hotel, Convention Center) on whose premises the Event will occur (hereinafter
“Location”) the affiliates of All Dance International and the respective directors, officers, representatives, members, agents,
administrator, successors and employees of All Dance International, the Location and their respective affiliates (hereinafter
collectively “Releases”) from any and all liability for negligence or any other claim judgment, loss, liability, damages costs and
expenses (including, without limitations, attorney’s fees and costs) arising out of or connected with any illness or injury (minimal,
serious, catastrophic, and/or death) that I may incur or sustain or 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, on my own behalf and/or on behalf of the Minor waive, release and discharge All Dance International and Releases from any and
all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for property
loss, property damage or property theft that may take place 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 Releases and Releases’ heirs, successors, assigns, executors and
administrators against loss from any further claims, demands or actions that may subsequently be brought by myself, Minor or by
any other persons on the account of damages of any character resulting to me or Minor in any way from the foregoing activities. I
further agree to reimburse and to make good to Releases any loss, damages, or costs Releases may have to pay as a result of any
such action, claim, or demand.

I, on my own behalf and/or on behalf of the Minor, hereby warrant that I have read this Liability Release in its entirety and fully
understand its contents.

I, on my own behalf and on/or behalf of the Minor, am aware that this form releases All Dance International from liability and
contains an acknowledgment of my voluntary and knowing assumption of the risk of injury or illness. I, on my own behalf and/or on
behalf of the Minor, further acknowledge that nothing in this Release constitutes a guarantee that the Event will occur. I, on my own
behalf and/or behalf of the Minor, have signed this document voluntarily and of my own free will.

I, on my own behalf and/or on behalf of the Minor, expressly agree that this Release is intended to be as broad and inclusive as is
permitted by the law of the State of ______________ and that if any portion thereof is held invalid, it is agreed that the balance
shall, notwithstanding, continue in full legal force and effect.

Signature of Participant: ________________________________________ Date: __________

Signature of Parent or Legal Guardian: ______________________________ Date: __________

Name of Minor (if applicable): _______________________________________

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ALL DANCE INTERNATIONAL
AUTHORIZATION FOR USE OF IMAGE, VOICE, PERFORMANCE AND LIKENESS

I understand that All Dance International from time to time produces promotional material relating to its programs. I understand that
as a Participant and/or spectator of the Event, I or the Minor I represent may be included in videotapes or photographs taken during
the Event.

Therefore, I, on my own behalf and/or on behalf of the Minor, without reservations or limitations hereby assign, transfer and grant to
All Dance International, its successors, assignees, licenses, sponsors and television networks, and all other commercial exhibitors the
exclusive right to photograph and/or videotape me or the Minor participant and to utilize such videotapes and photographs of my
or the 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 All Dance International nor any third party is under
any obligation to exercise any of the foregoing rights, licenses and privileges.

I further understand that my likeness or the likeness of the Minor may be copied/reproduced and distributed by means of various
media, including, but not limited to video presentations, simultaneous television broadcast/rebroadcast, radio
transmission/retransmission, news releases, mail-outs, e-mails, billboards, signs, brochures, placement on websites and/or other
electronic delivery, publication, display, or promotion on any and all other media, social networks, Facebook, Twitter, Instagram
and any other way via Internet. I further understand that my likeness or the likeness of the Minor participant may be subject to
reasonable modification or editing. I acknowledge that All Dance International has the right to make one or more photographs, audio
recordings, videotape or disk presentations, or other electronic reproductions of my likeness or the Minor’s likeness in accordance
with this Authorization for Use of Image, Voice, Performance or Likeness (hereinafter sometimes referred to simply as “this
Authorization”). I waive any right to inspect or approve the finished product or material in which the All Dance International may
eventually use my likeness or the likeness of the Minor Participant I represent.

EVENT AND COMPETITION RULES AND REGULATIONS

I, on my own behalf and/or on behalf of the Minor I represent, agree to abide by the rules and regulations established by All Dance
International in its Unified Ruler. I understand that I and/or the Minor that I represent should, at all times of the New Dancers
Championship And Convention 2018 Event behave with politeness and show an appropriate conduct and language, avoiding the use
any vulgar or abusive language. The use of illegal drugs is strictly forbidden. I acknowledge that All Dance International reserves
the right to suspend or dismiss any participant from the Event New Dancers Championship And Convention 2018 for failure to
comply with these rules and regulations.

MEDICAL RELEASE

I, on my own behalf and/or on behalf of the Minor, acknowledge and agree that participation in Event subjects me or the Minor to
possible physical illness or injury (minimal, serious, catastrophic and/or death) and that I, on my own behalf and/or on behalf of the
Minor, acknowledge that I am or the Minor is assuming the risk of such illness or injury participating in the Event. In the event of
such illness or injury, I authorize All Dance International or Chaperone to obtain necessary medical treatment for me or the Minor
and hereby, release and hold the Releases harmless in the exercise 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 my
behalf or on behalf of the Minor for any illness or injury that I or the Minor may sustain during the Event and while traveling to and
from the site of the Event whether or not the Event actually occurs.

Signature of Participant: ________________________________________ Date: __________

Signature of Parent or Legal Guardian: ______________________________ Date: __________

Name of Minor (if applicable): _______________________________________

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