Waiver | Parksville Academy O

Liability & Image Waiver

First name

Last name

Date of Birth of Child

The students name & anything we should know about them

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I or my child may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my o ability to participate in this program. my childs

Photo, video and Media Release: I understand Parksville Academy of Performing Arts may takes pictures and videos of students and activities to celebrate successes and for general marketing purposes. By signing up for classes, courses and events, I authorize Parksville Academy of Performing Arts to use and publish images, photographs, pictures, portraits, audio, video and/or film footage of myself and/or child(ren). These materials may be used, without payment or consideration, for publication purposes including, but not limited to, advertising and marketing campaigns, press releases, social media (Facebook, Twitter, Instagram, etc.), Parksville Academy of Performing Arts website, as well as printed materials such as flyers and brochures. I understand that Parksville Academy of Performing Arts will not use my or my child's full name in association with any photos or videos. I hereby waive any right I may have to review, inspect, edit or approve such publication and I release Parksville Academy of Performing Arts from any claims I may have against it for use of such images, photographs, pictures, portraits, audio, video and/or film footage of my child(ren). Please note: If you do not wish to have your child(ren)s picture/video taken, you must notify Parksville Academy of Performing Arts directly.

Your Signature

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