I understand that signing this student interview/photograph/video release statement allows my child who is in the AileyCamp summer program to be interviewed, photographed and/or videotaped by the AileyCamp staff, volunteers, and the media for the purpose of media coverage, promotional activities, or documentation. I understand that this release form does not guarantee the use of my child’s quotes, photograph or videotape appearance in any publication, broadcast, or release. By signing, I hereby grant my permission to members of the media and staff of Kansas City Friends of Alvin Ailey to use my child’s quotes, photographs, and/or videotape prior to use of publication.
I have enrolled my child/children in a program of strenuous physical activity, offered by KCFAA. I hereby affirm that my child (listed above) is in good physical condition and does not suffer from any disability that would prevent or limit participation in this dance program. In consideration of myself, my heirs and assigns, hereby release the KCFAA, from any claims, demands, and causes of action arising from my or the above named person’s participation in any of the above stated programs, and I hereby release the KCFAA from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls, tears, broken bones, shin splints, heat prostration, knee, lower back, or foot injuries and any other illness, soreness or injury however caused occurring before, during or after participation in any other of the programs offered at KCFAA or at any time, while in the vicinity of the premises of the above stated business, or in any activity sponsored, represented, or organized by KCFAA, for any reason. By checking the box, I hereby affirm that I have read and fully understand and agree with the information stated.
I, on behalf of myself and Camper, do hereby exempt, release, and forever discharge Kansas City Friends of Alvin Ailey (“KCFAA”) and Alvin Ailey Dance Foundation, Inc. (“Ailey”) and its directors, officers, agents, employees and instructors, from any and all claims which may occur from any cause whatsoever during or arising from Camper’s participation in AileyCamp, including any injury to Camper or damage to Camper’s property. KCFAA/Ailey shall not be responsible for and specifically disclaims any liability to Camper for any loss, theft, injury or liability incurred at KCFAA/Ailey, except if resulting significantly from the gross negligence of KCFAA/Ailey or its employees.
By checking the box below, I (parent/guardian) give my permission for (child) him/her to attend AileyCamp. I give my permission for him/her to engage in all AileyCamp activities including the following:
• Dance classes in modern, and jazz taught by professional dancers
• Creative expression including creative writing and art
• Personal development conducted by AileyCamp counselors
• Techniques of Performance class taught by the Camp Director
I understand that AileyCamp is a three and a half -week commitment and that my child must comply with the following rules:
• Respect for himself/herself and others
• Respect for the on-line process
• Focus and persistence
• Daily attendance (barring illness)
• No vacations during camp
• Wear tee-shirt and shorts each day
AileyCamp involves extensive heightened periods of physical activity including running, jumping, and floor exercise, and periods of emotional focus discussing teen/human issues such as pregnancy, drug/alcohol abuse, self-esteem, peer pressure and family relationships. I realize that with such heightened physical and emotional activity, my child may experience fatigue and will require plenty of rest and nutritional meals throughout the six weeks of the program. I understand that despite exacting safety practices and leadership by AileyCamp staff, a guarantee of absolute safety is impossible. I understand that my child obeying all rules, guidelines and professional instruction ensures the greatest level of safety.
To the best of my knowledge, I do not know of any physical or mental impairment that would hinder my child from participating in this program. In addition, all information I am providing in this packet is true and correct. I understand that in addition to the above rules, all Public Schools codes, policies and procedures apply under the umbrella of Kansas City Friends of Alvin Ailey’s partnership with the School Districts in the sponsorship of this program. I understand that AileyCamp staff may at any time remove my child from the program for non-compliance with program or district rules, and that at such time my child must surrender the AileyCamp uniform to the AileyCamp office and no longer return to the facility which houses the AileyCamp program.
I have read the above description of the AileyCamp program and I agree to hold AileyCamp and its sponsor, Kansas City Friends of Alvin Ailey, its employees, officers, directors and agents harmless for any accidents or injury which may occur or result from my child’s participation in this program.
