Ballet Workshop for Scouts Registration and Waiver

  • Ballet Workshop for Scouts Registration and Waiver: Sunday, 12/12/2021 at 10 a.m.

    Thank you for registering your scout for our workshop!
  • By enrolling my student, I assume all risks associated with dance instruction/classes. I agree that the Pittsburgh Ballet Theatre School (PBT School), Pittsburgh Ballet Theatre (PBT), and its Board of Directors, Faculty, staff, and volunteers shall not be liable in any way for any injuries sustained or loss of property while attending the school or any of its related functions. I hereby grant permission to the Directors and/or staff of PBT School to authorize hospital admission and any necessary medical, surgical, and emergency treatment (including blood or blood product, transfusions, and diagnostic procedures) for the registered student. Additionally, I grant permission for the administration of anesthesia to the registered student where medically necessary in case of emergency, accident, and illness and only in the case that a parent or designated alternate family representative cannot be contacted.
  • By enrolling, I grant permission for any photographs and/or video footage, which may include the student’s image and/or name, to be used for promotional purposes on television, newspapers, magazines, social media, or any other media. I grant permission for the registered student to be interviewed and/or to have quotations, text, and phrases collected from the student for promotional purposes.
  • 1. I am aware of the highly contagious nature of COVID-19 and the risk that my child(ren) and I may be exposed to or contract COVID-19 while on the premises of and/or participating in classes at the Pittsburgh Ballet Theatre and Pittsburgh Ballet Theatre School (collectively, “PBT”). I understand and acknowledge that being on the premises of and/or participating in classes at PBT may increase my child(ren)’s and my risk of being exposed to or contracting COVID-19 and that PBT cannot prevent my child(ren) and me from being exposed to or contracting COVID-19. 2. I agree that I am personally responsible for the safety of myself and my child(ren) while on the premises of and/or participating in classes at PBT. I agree that my child(ren) and I will comply with all PBT policies and rules, including but not limited to, all policies, guidelines, instructions, and posted signage. My child(ren) and I will not enter the premises of PBT or participate in classes at PBT if either myself, my child(ren), or any other members of our household are experiencing symptoms of COVID-19 (such as cough, shortness of breath, or fever), have a confirmed or suspected case of COVID-19, or have come in contact in the last 14 days with a person who has been confirmed or suspected of having COVID-19. I further agree to provide notice to PBT by emailing PBTSchool@pittsburghballet.org within 24 hours in the event myself, my child(ren), or any other member of our household tests positive for COVID-19. 3. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 while on the premises of and/or participating in classes at PBT and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself, my child(ren), and others, including, but not limited to, PBT employees, volunteers, and others on the premises of and/or participating in classes at PBT. I, on behalf of myself and my child(ren), voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, arising from or related to my child(ren) or me being exposed to or infected by COVID-19 while on the premises of and/or participating in classes at PBT (“Claims”). 4. On behalf of myself and my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless PBT and their owners, officers, directors, employees, agents, representatives, insurers, affiliates, successors and assigns (collectively, the “Releasees”) of and from the Claims, now know or hereinafter known, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PBT and their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after being on the premises and/or participating in classes at PBT. I promise, on behalf of myself and my child(ren), not to make or bring any Claims against PBT or any other Releasee and forever release and discharge PBT and all other Releasees from liability under such Claims. 5. This waiver of liability and assumption of the risk agreement constitutes the sole and entire agreement of PBT and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This agreement is binding on and shall inure to the benefit of PBT and me and our respective successors and assigns. All matters arising out of or related to this waiver of liability and assumption of the risk agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania, without giving effect to any choice of law provisions.
  • MM slash DD slash YYYY