GROOVE STREET PRODUCTIONS APPRENTICE CREW

First Name *

Last Name *

AGE *

Street Address *

City *

Province/ State? *

Post Code/Zip *

Phone Number *

Email Address *

In which city will you be Apprentice Crew? *

Additional Information

Emergency Contact Name *

Emergency Contact Phone # (with area code) *

Do you have any medical conditions, injuries or allergies we should know about? *

Do you feel comfortable dancing on the stage while assisting, or would you prefer being on the floor? *

Anything else you need us to know? *

I, the undersigned, being 18 years of age or older, on behalf of the Apprentice Crew member named above, understand that Groove Street Productions and the instructors thereof are not liable for personal injuries or loss of, or damage to, personal property. I understand that participating, as an assistant, in dance classes involves the risk of physical injury. I therefore assume all risks involved in the participation of the Groove Street Productions and/or Street Groove Convention weekend(s), whether it be I, or my participating minor child. I exempt, release and indemnify Groove Street Productions, Street Groove and the faculty thereof, including other assistants, volunteers and administrative assistants from any and all liability claims, demands or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. I understand that I (or my participating minor child) may decline to participate in any activity. I understand that Groove Street Productions from time to time produces promotional videos, photos and other materials relating to its conventions. I hereby grant Groove Street Productions and its agents, successors, assigns and licensees the perpetual right to use this Apprentice Crew member's name, likeness, photographs, voice, personal characteristics, and other personal identification (collectively "Likeness") and any digital, videotape, sound and audio-visual recordings in any way (collectively "Recordings") in any and all manner and media, now known or hereafter devised, throughout the world, for any and all purposes including, without limitation, in connection with the advertising and promotion of GSP Dance Conventions or Street Groove Hip Hop Conventions. By signing below (in the form of a "check mark" and a typed signature), I am acknowledging that I have read and agree to be bound by all of the rules and regulations stated here. *

I have read the liability waiver and fully understand and agree to its terms.

Signed (name of Parent/Guardian if registrant is under 18 years of age.) *