The School of Fine Arts
Wednesday, December 13, 2017

Activity Waiver - Dance

 
School of Fine Arts Classes, 2017-2018
Activity Waiver
First Baptist Church, SOFA, Decatur, AL
(This document is required for all students enrolling in dance.)
 
Participant: ______________________________
 
Parent/Guardian: _________________________
 
Address:________________________________________
 
Cell Phone: _________________________________________
 
Emergency Contact (someone other than parent/guardian:
 
__________________________________________________
 
Emergency Contact Phone: _______________________________________
 
Allergies or medical conditions:_____________________
 
Medications:_____________________________________
 
Family Physician/Pediatrician: ______________________
 
Phone: _________________________________________
 
 
In the event the participant becomes ill or injured in a SoFA class or on FBC premises, the parent will be immediately contacted. If parent is not present and cannot be reached,  permission is granted to take whatever steps necessary to administer first aid and consent is provided to initiate emergency medical treatment, including
administration of medication as required.
 
Further, the participant (or parent/guardian) agrees  to waive, release, indemnify, defend and hold harmless FBC, SoFA,  the Director and Instructors of SoFA for any injury arising directly/indirectly from a SoFA class, activity,  or presence on FBC campus.
 
 
Parent/Guardian Signature:
__________________________________________________________
 
Date: _____________________________________________________