PHOTOGRAPHY and MEDICAL TREATMENT RELEASE, & RELEASE OF LIABILITY AND
INDEMNIFICATION:
I hereby grant permission on behalf of myself and my family to be photographed for the afore
mentioned class by staff, parents, or contracted photographer(s) at anytime during the course of any
class in which I or my family participate. I further grant full permission to the administrators of the
class to copyright, use, reproduce, publish or display all photographs taken of myself or my family
for the purpose of advertising, marketing and, public performances or displays. It is my
understanding that all photographs taken by the photographer will be copyrighted, that no fee will be
charged by me or my family for our services, and that all photographs may be published at any
future time.
In the event of an accident or illness, the administrators of this class have my permission to secure
medical attention for myself or my child, if I am unable to do so. Any attending physician(s) has my
consent to administer any emergency medical measures which he or she deem necessary for the
well-being of myself or my child.
I hereby release, discharge, and agree to indemnify, defend, and hold harmless the administrators,
landlord, officers, employees, student helpers, agents, volunteers and parents of Grand Rapids
Capoeira from any and all responsibility, liability, claims, losses, damages, and causes of action on
behalf of such minor child, myself, or my family, arising out of or in any way associated with any or
all participation in the afore mentioned class or related activities, including negligence, but not
excluding liability or claims that result from the intentional disregard or reckless conduct of those
organizations or individuals identified herein.
I HAVE READ, UNDERSTAND AND AGREE TO ALL OF THE TERMS AND CONDITIONS OR
POLICIES CONTAINED IN THIS REGISTRATION/WAIVER AGREEMENT. I ACKNOWLEDGE
THAT THE PERSONAL INFORMATION THAT I HAVE PROVIDE IS TRUE AND ACCURATE AND
THAT I SHALL BE HELD LEGALLY RESPONSIBLE FOR ANY AND ALL INCORRECT OR
INACCURATE INFORMATION.
Grand Rapids Capoeira
