MEDICAL AUTHORIZATION

I/we, the undersigned parent(s) or legal guardian of the minor listed above, do hereby authorize in an emergent or nonemergent

situation any administration of first aid, the use of an ambulance, x-ray examination, anesthetic, dental, medical

or surgical diagnosis or treatment by any physician or dentist licensed by the state of Texas and hospital service that may

be rendered to said minor under the general, specific or special consent of the temporary custodian of the minor, whether

such diagnosis or treatment is rendered at the offices of the physician or dentist to call in any necessary consultants, in

his/their discretion.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to

encourage those persons who have temporary custody of the minor, and said physician or dentist to exercise his/their

best judgment as to the requirements of such diagnosis of medical, dental or surgical treatment.

ACCIDENT WAIVER, PHOTO RELEASE & RELEASE OF LIABILITY

I hereby assume all of the risks of participation, including by way of example and not limitation, any risks that may arise from negligence

or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned,

maintained or controlled by them or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised

to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my

participation in this activity or event.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, staff, and organizers

of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors,

administrators, heirs, next of kin, successors, and assigns as follows:

(A) I waive, release, and discharge from any and all liability, including but not limited to, liability arising from the negligence or fault of

the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of an kind which

may hereafter occur to me including my traveling to and from this event, The following Entities or Persons: Danceline Productions

USA, Inc., Danceline Staff/Instructors, Volunteers, Host locations and/or their directors, officers, employees, volunteers,

representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers.

(B) I indemnify hold harmless, and promise not to sue the entities or persons mentioned in this paragraph from any and all liabilities or

claims made as a result of participation in this activity or event, whether caused by negligence of release or otherwise.

I acknowledge that this activity or even may involve a test of a person’s physical or mental limits and may carry with it the potential for

death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature,

weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants,

volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks

are not only inherent to participants, but are also present for volunteers.

I understand that as this event or related activities, I may be photographed. I agree to allow my photo , video, or film likeness to be

used for any legitimate purpose by Danceline Productions USA, Inc., the event holders, producers, sponsors, organizers, and assign.

The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent

permissible under applicable law.

PARTICIPANT OR PARENT/GUARDIAN AGREEMENT

The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually an on behalf of the child or ward to the terms of the accident waiver, release of liability and medical authorization set forth above.

I certify that I have read this document, and I fully understand its content. I am aware that this is a blanket release of liability/medical authorization and a contract and I sign it of my own free will.