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Please upload a photo or scan of the front AND back of the student's medical insurance card.
As the enrolled participant and/or the parent/guardian of the participant, I agree and understand that dance/
training is a potentially hazardous activity. I recognize that there are risks inherent in dance training including
but not limited to serious physical injury. The participant hereby agrees to participate in activities of the
Kansas City Ballet School (KCBS) and hereby agrees to indemnify and hold harmless KCBS, its instructors,
officers, directors, agents and employees against any liability resulting from any injury that may occur to the
participant while participating in activities of KCBS and the R.O.A.D. Scholarship Program.
The participant also agrees to indemnify KCBS for any damages incurred arising from any claims, demand,
action or course of action by the participant. The participant authorizes any representative of KCBS to
have the participant treated in any medical emergency during their participation in activities of KCBS and
the R.O.A.D. Scholarship Program. Further, the participant and/or parent/guardian agrees to pay all costs
associated with medical care and transportation for the participant. Any medical/health issues of which
the staff should be aware are disclosed on the Health History Form. The parent/guardian will keep KCBS
informed of any changes in the participant’s health.
Photography/Videography/Social Media Release
As the enrolled participant and/or the parent/guardian of the enrolled participant, I authorize Kansas
City Ballet and/or its representative, agent or employee to photograph and/or videotape and use any
photograph/likeness of me or my minor child for any purpose, including publicity, choreographic archives,
promotional materials and/or any other reason deemed appropriate by the School Director and the
Community Engagement and Education Manager.