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CONSENT FOR MEDICAL TREATMENT

In the event of a Medical Emergency Benicia Ballet Inc. and their personnel will make every effort to contact Parent/Guardian and Emergency contacts supplied at the time of registration.  If Benicia Ballet Inc. and/or their personnel are unable to contact Parent/Guardian or Emergency contacts you grant permission to Benicia Ballet inc. to summon Medical Treatment deemed necessary by Benicia Ballet Inc. and their personnel.

 

As the Parent, Agency Representative, or Legal Guardian, I hereby give consent to Benicia Ballet and Benicia Ballet Theatre to provide all emergency medical or dental care prescribed by a duly licensed physician (MD) or dentist (DDS) for:

This care may be given under whatever conditions are necessary of preserve the life, limb, or well-being of my dependent.

Optional Information:
Please consider disclosing any previous or existing injuries or physical conditions, medications, allergies, or conditions of which Benicia Ballet, Inc and Benicia Ballet Theatre needs to be aware. 

HOLD HARMLESS

I agree to hold Benicia Ballet, Inc and Benicia Ballet Theatre (BBT), their premises and personnel harmless for any losses, damages, or liabilities attributable to the negligence of any agent or employee of Benicia Ballet, Inc or BBT or any third party affiliate of the school. The assignee agrees that they have doctor's permission for their child or self to engage in these dance rehearsals and productions and/or the assignee takes sole responsibility for participation in these activities.

PHOTO RELEASE

PHOTO RELEASE: I hereby grant permission to Benicia Ballet, Inc and Benicia Ballet Theatre to use photographs and/or video taken in 2023-2024 for publications, news releases, news releases, online, and in other communications related to our mission.

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