(such as heart, back, medical, allergy, muscular, diabetes, epilepsy, chemical or neurological condition, special medical, knee, kidney, etc.)
I understand the risk of injury is inherent in any physical activity and I, on behalf
of my child knowingly and voluntarily accept that risk. I the undersigned, for
myself, my heirs, administrators, and executors, hereby waive and release
Madeleine Walker Coastal Ballet Theater LLC and its staff from any and all
claims or damages of any kind arising out of my participation in the exercise or
dance program and that he/she has been examined by a licensed physician and
found to be in proper physical condition to participate in said program.
I, the undersigned, do hereby authorize Madeleine Walker Coastal Ballet
Theater LLC or its staff to obtain medical treatment for my said child in
emergency situations where I cannot be reached in time to authorize the treating
physician to provide such emergency medical services. This includes the power
to authorize any and all treatment deemed necessary under the circumstances
by a licensed physician. This power is in essence a power of attorney and shall
remain in effect from the date signed below.
