Summer Dance Application - Kansas City Friends of Alvin Ailey

Consent Agreements
INTERVIEW / PHOTOGRAPH / VIDEO*
I understand that signing this student interview/photograph/video release statement allows my child who is in the Summer Dance summer program to be interviewed, photographed and/or videotaped by the Summer Dance 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.
- INTERVIEW / PHOTOGRAPH / VIDEO CONSENT
Physical Activity*
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.
- PHYSICAL ACTIVITY CONSENT
RELEASE OF LIABILITY*
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 all claims which may occur from any cause whatsoever during or arising from your child’s participation in Summer Dance, including any injury to students or damage to student’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.
- I agree to the release of liability.

SUMMER DANCE T-SHIRT Your child will receive one tee-shirt. Please enter his/her child or adult sizes below.
Summer Dance Tee-Shirt*
Adult Sizes Do you wish to purchase an additional Tee-Shirt for $5? If yes, please bring $5 exact amount the first week of camp.
I need a tablet if we would need to go Virtual**
I need Wi-Fi or a Hot Spot if we would need to go Virtual**
PARENTAL CONSENT*
By checking the box below, I (parent/guardian) give my permission for (child) him/her to attend Summer Dance. I give my permission for him/her to engage in all Summer Dance activities.

I understand that Summer Dance is four week and to remain in the program and receive credit my child will attend each day. My child will follow the rules of Summer Dance:

• Respect for himself/herself and others
• Focus and persistence
• Daily attendance (barring illness)
• No vacations during camp
• Wear tee-shirt and dancewear daily.

Summer Dance 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 Summer Dance 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 Summer Dance staff may at any time remove my child from the program for non-compliance with program or district rules.

I have read the above description of the Summer Dance program and I agree to hold Summer Dance 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.
I CONSENT TO THE ABOVE

2023 Summer Dance at Lincoln College Prep Middle School Enrollment

Step 1 of 3

PARENT/GUARDIAN INFORMATION / INFORMACIÓN DE LOS PADRES

STUDENT INFORMATION / INFORMACIÓN DEL ESTUDIANTE

Demographic Info / Información demográfica