Capitol Movement

Family Educational Rights and Privacy Act (FERPA) Consent

Release executed on the date shown above in the form (‘by the Parent/Guardian Releaser shown above in this form’), FOR (Child/Dancer shown above in this form, if under the age of 18), to Capitol Movement, Inc. (the ‘Release’s’) of 222 G Street, SW Washington, DC 20024.

I, the Releaser, being of lawful age, in consideration of being permitted to participate in, or granting permission for my child to participate in the Dance training and audition, run and/or operated by Release’s, WAIVE, RELEASE, and DISCHARGE the Release’s, its owners, officers, directors, employees, members, agents, assigns, legal representatives and successors, and all business associates and partners involved in the presentation of the above activity, and each of them their owners, officers, and employees, from all liability for or by reason of any damage, loss or injury to person or property, even injury resulting in the death of the Releaser, which has been or may be sustained as consequence of the Releaser’s participation in the activity described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Release’s. I acknowledge that I do not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent me from participating in the above mentioned activity. I understand that this waiver is active, good and sufficient for all after school classes and all activities associated for the calendar year 2022.

Capitol Movement, Inc are authorized to make, photograph, or record any image of (‘Child/Dancer shown above in this form’), and to incorporate and use such image in any photograph(s), video(s) and/or printed or recorded medium for any commercial, trade, or other lawful purposes as they shall desire and in any manner they deem advantageous, including for example, production and marketing materials to promote said companies. Dancer (and parent) hereby releases any and all claims he/she may have to ownership of such photographs, videos and other images recorded of the Dancer, including any and all copyrights and trademark rights that he/she may have, and assigns such rights to the above said companies. Dancer (and parent) further waives any right that he/she may have to inspect or approve of the finished product or the advertising of the finished product.

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I UNDERSTAND THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS, WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEE(S). The (‘Parent/Guardian Releaser shown in this form above’) has executed this Waiver and Release at Washington DC, as of the date shown in this form.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statement or inducement apart from the forgoing written agreement have been made. This waiver, release and indemnification agreement specifically embraces each and every event sanctioned, authorized or promoted by said releases during the entire season and applies to each and every event, or activity mentioned, and has the same effect as if executed after each and every activity or event in which the undersigned participates so that the parties herein intended to be released indemnified as to each and every event described.

If you prefer, you can download this pdf, fill out the form and click here to email the filled out and signed PDF, to Stephanie Jojokian at Capitol Movement