The Cecchetti Society of Canada presents:

Release Forms
Page
2
of
3
PERMISSION
FORM
FOR
MINOR
STUDENTS
AND
MEDICAL
RELEASE
Name
of
Participant
(Student):
____________________________________________________
Participant
or
Legal
Guardian
Signature:
____________________________________________
Allergies/Medical
Conditions:
_____________________________________________________
In
case
of
an
emergency,
please
contact:
Name:
___________________________________________
Phone
Number:
_______________
E‐mail:
___________________________________________
Relationship:
_________________
By
signing
the
above
you
agree
to
the
following
terms
and
conditions:
You
certify
that
you
are
an
adult
attending
the
course
or
the
parent
or
legal
guardian
of
the
minor
designated,
and
that
you
grant
permission
for
yourself
or
said
minor
to
participate
in
the
2013
National
Cecchetti
Conference
and
Summer
School
in
Toronto,
Ontario.
The
participant
or
guardian
hereby
waives
all
claims
for
any
injuries
or
illnesses,
damage,
or
loss
to
his/her
person
and
property
that
may
result
from
participation
in
the
course
and
releases
the
Cecchetti
Society
of
Canada,
Cecchetti
Ontario,
the
National
Ballet
School,
or
any/all
employees,
volunteers,
and
organizers
from
any
liability
for
injury,
damage
or
loss
which
may
be
caused
by
any
act
or
omission
of
any
of
them
on
the
premises,
in
their
residence
of
choice,
or
while
in
travel.
PHOTOGRAPHY
AND
VIDEO
RELEASE
The
Cecchetti
Society
of
Canada
shall
have
the
right
to
use
names,
photographs,
videos,
or
other
likenesses
of
the
participant
in
the
course,
and
exhibit
the
same
through
any
medium
for
advertising,
promotional,
or
commercial
use.

All
reproductions
are
exclusive
property
of
the
Cecchetti
Society
of
Canada,
without
compensation
to
the
participant,
family
members,
or
agents.

By
signing
below,
I
have
read
and
understood
this
photography
and
video
release
and
agree
to
the
conditions
explained.
Name
of
Participant
(student):
____________________________________________________
Participant
or
Legal
Guardian
Signature:
____________________________________________
Date:
__________________________
2013 National Cecchetti Conference and Summer School