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PLEASE NOTE: All children and young adults with Down syndrome are required to have a full radiological examination establishing the absence of Atlanto-Axial Instability before she/he may participate in sports or events which by their very nature, may result in hyperextension, radical flexion or direct pressure on neck or upper spine.
I am at least 18 years old and have submitted the attached application for participation in the FOSTER-SCHMIDT DANCE ACADEMY.I represent and warrant that, to the best of my knowledge and belief, I am physically and mentally able to participate in FOSTER-SCHMIDT DANCE ACADEMY activities. I also represent that a licensed physician has reviewed the health information contained in my application and has certified, based on an independent medical examination, that there is no medical evidence which would preclude me from participating in the FOSTER-SCHMIDT DANCE ACADEMY.The FOSTER-SCHMIDT DANCE ACADEMY has my permission (both during and anytime after), to use my likeness, name, voice or words in either television, radio, film, newspaper, magazines and other media, and in any form, for the purpose of advertising or communicating the purpose and activities of the FOSTER-SCHMIDT DANCE ACADEMY and/or ap[plying for funds to support these purposes and activities.If, during my participation in FOSTER-SCHMIDT DANCE ACADEMY activities, I should need emergency medical treatment, and I am not able to give my consent or make my own arrangements for that treatment because of my injuries, I authorize the FOSTER-SCHMIDT DANCE ACADEMY to take whatever measures necessary to protect my health and well-being, including if necessary hospitalization.I, the athlete named above, have read this paper and fully understand the provisions of the release that I am signing. I understand that by signing this paper I am saying that I agree with the provisions of this release.
I am at least 18 years old and have submitted the attached application for participation in the JENSEN-SCHMIDT TENNIS ACADEMY.I represent and warrant that, to the best of my knowledge and belief, I am physically and mentally able to participate in JENSEN-SCHMIDT TENNIS ACADEMY activities. I also represent that a licensed physician has reviewed the health information contained in my application and has certified, based on an independent medical examination, that there is no medical evidence which would preclude me from participating in the JENSEN-SCHMIDT TENNIS ACADEMY.The JENSEN-SCHMIDT TENNIS ACADEMY has my permission (both during and anytime after), to use my likeness, name, voice or words in either television, radio, film, newspaper, magazines and other media, and in any form, for the purpose of advertising or communicating the purpose and activities of the JENSEN-SCHMIDT TENNIS ACADEMY and/or applying for funds to support these purposes and activities.If, during my participation in JENSEN-SCHMIDT TENNIS ACADEMY activities, I should need emergency medical treatment, and I am not able to give my consent or make my own arrangements for that treatment because of my injuries, I authorize the JENSEN-SCHMIDT TENNIS ACADEMY to take whatever measures necessary to protect my health and well-being, including if necessary hospitalization.I, the athlete named above, have read this paper and fully understand the provisions of the release that I am signing. I understand that by signing this paper I am saying that I agree with the provisions of this release.
I am the parent/guardian of the minor athlete, on whose behalf I have submitted the attached application for participation in the FOSTER-SCHMIDT DANCE ACADEMY Y. I hereby represent that the athlete has my permission to participate in FOSTER-SCHMIDT DANCE ACADEMY activities.I further represent and warrant that, to the best of my knowledge and belief, the athlete is physically and mentally able to participate in JENSEN-SCHMIDT TENNIS ACADEMY activities. With my approval, a licensed physician has reviewed the health information set forth n the athlete’s application and has certified, based on an independent medical examination, that there is no medical evidence which would preclude the athlete from participating in the FOSTER-SCHMIDT DANCE ACADEMY.In permitting the athlete to participate in the FOSTER-SCHMIDT DANCE ACADEMY, I am specifically granting my permission (both during and anytime after), to use the athlete’s likeness, name, voice or words in either television, radio, film, newspaper, magazines and other media, and in any form, for the purpose of advertising or communicating the purpose and activities of the FOSTER-SCHMIDT DANCE ACADEMY and/or applying for funds to support these purposes and activities.If, during the athlete’s participation in FOSTER-SCHMIDT DANCE ACADEMY activities, and she/he should need emergency medical treatment, and I am not personally present to give my consent or make arrangements for that treatment, I authorize the FOSTER-SCHMIDT DANCE ACADEMY to take whatever measures necessary to protect the athlete’s health and well-being, including if necessary hospitalization. I am the parent (guardian) of the athlete named in this application. I have read and fully understand the provisions of the above release, and have explained these provisions to the athlete. Through my signature on this application, I am agreeing to the above provisions on my own behalf and on the behalf of the athlete named above.
I am the parent/guardian of the minor athlete, on whose behalf I have submitted the attached application for participation in the JENSEN-SCHMIDT TENNIS ACADEMY. I hereby represent that the athlete has my permission to participate in JENSEN-SCHMIDT TENNIS ACADEMY activities.I further represent and warrant that, to the best of my knowledge and belief, the athlete is physically and mentally able to participate in JENSEN-SCHMIDT TENNIS ACADEMY activities. With my approval, a licensed physician has reviewed the health information set forth n the athlete’s application and has certified, based on an independent medical examination, that there is no medical evidence which would preclude the athlete from participating in the JENSEN-SCHMIDT TENNIS ACADEMY.In permitting the athlete to participate in the JENSEN-SCHMIDT TENNIS ACADEMY, I am specifically granting my permission (both during and anytime after), to use the athlete’s likeness, name, voice or words in either television, radio, film, newspaper, magazines and other media, and in any form, for the purpose of advertising or communicating the purpose and activities of the JENSEN-SCHMIDT TENNIS ACADEMY and/or applying for funds to support these purposes and activities.If, during the athlete’s participation in JENSEN-SCHMIDT TENNIS ACADEMY activities, and she/he should need emergency medical treatment, and I am not personally present to give my consent or make arrangements for that treatment, I authorize the JENSEN-SCHMIDT TENNIS ACADEMY to take whatever measures necessary to protect the athlete’s health and well-being, including if necessary hospitalization. I am the parent (guardian) of the athlete named in this application. I have read and fully understand the provisions of the above release, and have explained these provisions to the athlete. Through my signature on this application, I am agreeing to the above provisions on my own behalf and on the behalf of the athlete named above.