In consideration of the Southwest Virginia Ballet’s (SVB) grant of an audition and/or selection to participate in a performance, rehearsal or class staged by SVB, I hereby waive any and all claims for myself and my heirs for any child or ward in my care or custody so participating (the “Minor” named above) against SVB and each of its agents, officers, and employees, for injury or illness which may directly or indirectly result from my participation. And I further agree to save and hold said parties harmless and agree to indemnify each if said persons against all alibility for and loss, cost, injury, or damage to persons or property which may arise by virtue of the undersigned engaging in the activities associated with SVB. Furthermore, the undersigned do hereby expressly stipulate and agree to indemnify and forever hold harmless SVB, Star City School of Ballet, their successors and assigns, employees, representatives, agents, officers, and directors, against loss from any and all further claims, demands or actions in law or equity that may hereafter at any time be made or brought by the said Minor or anyone on behalf of said Minor for the purpose of enforcing a claim against them for damages on account of any injuries sustained in consequence of participation in this activity or any related SVB activity by the Minor or participant. Furthermore, I state that the Minor is in proper physical condition to participate with SVB. Furthermore, it is agreed that any participant may be photographed or videotaped in Audition, Rehearsal or Performance at the direction of SVB and agreed that such photographs or videos may be used by SVB for promotional and archival purposes.

To the best of my knowledge all the information in the application is true and factual. I understand and agree that any false statement made in this application could be grounds for denial or revocation of a scholarship.