EVENTS IN MOTION "PERFORMER" WAIVER

Name_______________________________________ Age ______________

Street Address__________________________________________________

City __________________________ State___________ Zip _____________

Home Phone _______________________ Cell Phone __________________

Email _________________________________________________________

Release

I,  _________________________ do hereby release Events in Motion, Ellen Menking Hess, staff and agents from any and all liability for injury to myself incurred by reason of participation in functions, at rehearsals, shows, events, classes, during transportation to and from any event or activity. I acknowledge that I am physically and emotionally able to participate. I, the undersigned, acknowledge that I have read and understand the above and that I knowingly execute this release from liability and negligence. I give Events in Motion permission to use video and photos of my performances and other related activity with Events in Motion in brochures, website, videos for clients and other collateral. I agree to not use any choreography learned while with Events in Motion for any professional or non-professional activities including instruction, auditions or other presentations. Any shows or related offers I receive as a result of a contact through Events in Motion whether at an event or other will go through Events in Motion. I agree to not discuss fees with clients of Events in Motion or other performers. I understand that information learned through Events in Motion is confidential and I will not disclose to any competitive organizations. I agree to not recruit Events in Motion Performers. I give permission to administer medical assistance as deemed necessary in case of an emergency and agree to the financial responsibility to this action.

Signed___________________________________ Date____________________

Health Insurance Company_________________ Policy Number_____________

Emergency contact name and phone number ___________________________

Please supply any pertinent medical information

_______________________________________________________________

EVENTS IN MOTION

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