First Name *

Last Name *

Email *

Email (Confirmation) *

Age *

Current School *

Grade/Class Standing *

Home State *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone *

Is there any additional information we need to know about?

This is a legally binding release made to Grand Valley State University. I fully recognize that there are dangers and risks to which I may be exposed by participating in the LDT Audition Prep Clinic, an event sponsored by the Grand Valley State University Laker Dance Team. I understand the University cannot guarantee my personal safety while I am participating in this event. There are dangers and risks associated with all physical activity including the risk of physical injury.  

During this event, you may be invited to participate in a variety of physical activities. All physical activity involves a range of inherent risks. Consequently, you should make sure you have adequate health to participate in these activities. It is your responsibility to check with a physician of your choice about your health status if there is any question regarding your fitness for participation. If at any time during participation, you experience any physical distress, or have any questions or concerns regarding your participation, see your instructor immediately. Your participation in activity is voluntary.  

Some types of equipment used in physical activity have unique characteristics and, if improperly used, can be dangerous and result in injury. Before you use any equipment, make sure you know how it works, and it is in safe working order. Safety equipment may be required for some class activities. Failure to use equipment as intended will increase your risk of injury to yourself and, possibly, to others.  

People participating in events offered by the Laker Dance Team assume the following responsibilities:  

• Will comply fully with all rules, directions, and guidelines concerning physical activities and the safe use of equipment.  

• Will notify the instructor or building manager immediately if any unsafe or hazardous situations or unsafe practices come to his/her attention. • Will limit his/her participation to planned class/event activities as directed by the instructor. 

• Will stop participating if the participant feels he/she cannot continue safely. I have read the above statements describing risks and responsibilities.  

I understand the potential risks associated with participation in physical activity. I understand I should consult with a physician to determine my suitability for participation if there is any question about its appropriateness. I understand I should consult with the instructor if I have any uncertainty or concerns regarding my participation as well as questions/doubts about safety during class activities. My questions about this agreement have been answered to my satisfaction. While I participate in this event, I agree to follow the behavior guidelines outlined in the Student Code of Conduct and if I do not comply with those conditions, or any of the responsibilities outlined above, I understand this may result in dismissal from the event.  

Please acknowledge that you have thoroughly read through the text above and consent to your participation in the Laker Dance Team 2026 Audition Prep Clinic

Required if Dancer is under the age of 18. 

* If you are under the age of 18, please fill out the Minor Release Information below *

As the parent/legal guardian/foster parent of the minor child above, I hereby certify that the above information is the most up-to-date and correct to the best of my knowledge that I agree to the following as a condition of my dancer's participation in Grand Valley State University (GVSU) program or visit and/or related activities. I give my permission to GVSU, St. Mary’s Hospital, Spectrum Health Care System, North Ottawa Community Hospital, Metropolitan Health Care System or other health care providers to provide, seek, obtain, or approve any routine, necessary, or emergency health care during the minor child’s involvement in the GVSU programs. I understand that this authorization is given in advance of any specific diagnosis, or treatment or medical care being required and is to serve as specific consent to any and all such diagnosis, treatment or hospital care which may be deemed advisable. I understand my rights under the Health Insurance Portability and Accountability Act (HIPAA) and authorize GVSU to release information as necessary for managing program healthcare. I acknowledge that participation in the camp/activity/visit and/or related activities involves assumed and inherent risk of personal injury. I assume such risk on behalf of the minor child and give my permission to the minor child to participate in all program activities. I release and agree to hold harmless GVSU, its Board of Trustees, students and employees from all claims, actions, damages and liabilities for personal injury, damage or illness relating to or arising out of any activity except where the injury, damage or illness is caused by the gross negligence of the university’s employees. I understand that the minor child will be subject to the rules and regulations of the GVSU camp/activity/visit and/or related activity. I understand that any person who repeatedly disobeys University policies or procedures will be immediately expelled from the program. GVSU is not responsible for lost or stolen property.

Please acknowledge that you have thoroughly read through the text above and consent to your dancer's participation in the Laker Dance Team's 2026 Audition Prep Clinic.

I hereby authorize Grand Valley State University to: (a) Record my child’s likeness and voice on a video, audio, photographic, digital, and electronic or any other medium. (b) Use, reproduce, exhibit or distribute in any medium (e.g. print publications, video tapes, Internet/WWW) these recordings for any purpose that the University, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts. I give permission to Grand Valley State University to use, without charge and without reservation, my child’s likeness in any medium and for any lawful purpose, including promoting the University, its programs and services. I waive any rights of action I may have and release Grand Valley State University and its licensees from any and all claims I may have arising from my child’s likeness, including any rights to sue for defamation or violation of my rights of privacy and publicity.

I hereby consent to my dancer's media release on the GVSU Laker Dance Team's Social Media Platforms *
Yes
No