Blackbird Dance Circus & Healing 1640 S LA Cienega Blvd LA, CA 90035

Parental Consent and Assumption of Risk for Participation in Arts Programs

I do hereby give my consent for my child(ren) to participate in the activity program represented with Blackbird Dance Co.

I understand and acknowledge that these activities, by their very nature, pose potential physical risks and these activities are completely voluntary.

I understand and acknowledge that in order for my child(ren) to participate in these activities, my child(ren) and I agree to assume liability and responsibility for any and all potential risks which may be associated with participation in such activities.

I understand, acknowledge and agree that Blackbird Dance Co, its employees, officers, agents, affiliates, personnel, or volunteers shall not be liable for any injury/illness suffered by my child(ren) which is incident to and/or associated with preparing for and/or participating in this activity.

I acknowledge that I have carefully read this PARENT CONSENT FOR PARTICIPATION IN DANCE AND CIRCUS PROGRAMS FORM and I understand and agree to its terms.

Medical Authorization

Should it be necessary for my child(ren) to have medical treatment while participating in this activity, I hereby give Blackbird Dance Co personnel permission to use their judgment in obtaining medical services for my child(ren), and I give permission to the physician elected by the Blackbird Dance Co personnel to render medical treatment deemed necessary and appropriate by the physician. I understand that Blackbird Dance Co has no insurance covering such medical and hospital costs incurred by my child(ren) and therefore any costs for such treatments shall be my responsibility.