RELEVÉ AT THE REFINERY AGES 13+

Parent/Guardian Information

Class Selection

Pricing / Package Selection

Additional Information

Photo, Video, Audio & Publicity Release

I am the Dancer or, if the Dancer is under 18 years of age, the Dancer’s Parent or Legal Guardian. I

authorize Relevé at The Refinery, The Refinery, and their authorized representatives to photograph, film,

record, livestream, and otherwise capture the Dancer’s name, image, likeness, voice, performance,

choreography, participation, and biographical information during classes, rehearsals, performances,

competitions, events, photoshoots, and other Program activities.

I grant the Program a perpetual, worldwide, royalty-free right to reproduce, edit, publish, display, distribute,

transmit, advertise, and otherwise use such materials for lawful Program-related purposes, including:

• Websites and social-media platforms;

• Promotional and advertising materials;

• Printed programs, brochures, flyers, and catalogs;

• News and publicity;

• Educational and archival materials;

• Fundraising and grant materials;

• Livestreams, recordings, and performance documentation; and

• Other print, digital, broadcast, or electronic media.

I understand that the materials may be edited, combined with other materials, or used without identifying

the Dancer by name. I waive any right to inspect or approve the finished material or the manner in which it

is used.

I understand that neither the Dancer nor the Parent or Legal Guardian will receive royalties, fees, ownership

rights, or other compensation because of such use. The Program will not sell an individual Dancer’s image

or likeness to an unrelated third party for endorsement of an unrelated product without obtaining additional

permission.

This release does not authorize record

Assumption of Risk, Release & Waiver of Liability

Important — Please Read Carefully

Dance and physical training involve strenuous movement and inherent risks. These activities may include

ballet, pointe, contemporary dance, modern dance, jazz, tap, acrobatics, partnering, improvisation,

conditioning, stretching, strength training, rehearsals, performances, competitions, auditions, workshops,

use of theatrical equipment, and activities occurring at The Refinery or another Program-approved location.

Risks may include, without limitation, falls, collisions, overexertion, dehydration, muscle strains, sprains,

fractures, dislocations, concussion, aggravation of a prior condition, illness, permanent injury, paralysis, or

death. Some risks may arise from the actions of the Dancer, other participants, instructors, equipment,

facilities, flooring, staging, props, costumes, or other conditions that cannot be completely eliminated.

The Dancer and Parent or Legal Guardian knowingly and voluntarily assume all ordinary and inherent risks

associated with participation in Program activities, whether known or unknown and whether specifically

described in this Agreement or not.

Release of Ordinary Negligence

TO THE FULLEST EXTENT PERMITTED BY TEXAS LAW, THE DANCER AND PARENT OR LEGAL GUARDIAN

RELEASE AND DISCHARGE RELEVÉ AT THE REFINERY, THE REFINERY, BRIAN STEVENS, AND EACH OF

THEIR OWNERS, DIRECTORS, OFFICERS, FACULTY MEMBERS, EMPLOYEES, INDEPENDENT

CONTRACTORS, VOLUNTEERS, AGENTS, REPRESENTATIVES, LANDLORDS, SUCCESSORS, AND ASSIGNS—

COLLECTIVELY, THE “RELEASED PARTIES”—FROM CLAIMS FOR PERSONAL INJURY, ILLNESS, DEATH,

OR PROPERTY DAMAGE ARISING FROM OR RELATED TO PARTICIPATION IN PROGRAM ACTIVITIES,

INCLUDING CLAIMS CAUSED IN WHOLE OR IN PART BY THE ORDINARY NEGLIGENCE OF A RELEASED

PARTY.

This release includes, to the fullest extent permitted by law, claims concerning negligent instruction,

supervision, maintenance, inspection, selection of equipment, administration of first aid, emergency

response, or the condition of the premises.

THIS RELEASE DOES NOT APPLY TO GROSS NEGLIGENCE, RECKLESS OR WILLFUL MISCONDUCT,

INTENTIONAL MISCONDUCT, OR ANY LIABILITY THAT CANNOT LAWFULLY BE WAIVED.

The Dancer and Parent or Legal Guardian acknowledge that:

1. Participation is voluntary;

2. The Dancer is responsible for following faculty instructions and Program safety rules;

3. The Dancer must stop participating and notify a faculty member if the Dancer experiences pain,

dizziness, illness, injury, or another unsafe condition;

4. The Program has not represented that participation will be free from injury;

5. No medical condition or injury has been concealed from the Program; and

6. The Dancer should obtain appropriate medical advice before participating whenever there is a question

about the Dancer’s ability to participate safely.