I hereby agree to participate in the 2019 Music for All Summer Symposium listed on the front of this application. I understand that Music for All, Inc., Bands of America, Orchestra America, and their respective officers, directors, agents (including Ball State University, JEN Jazz Education Network, Indianapolis Symphony Orchestra, Delaware County and their respective directors, officers, employees, and agents) and employees shall not be nor later become, liable or responsible in any way in conjunction with services, for any death, injury, damage, delay or irregularity which may occur while participating in this Music for All sponsored event (the “Sponsored Event”).
Also, in case of emergency, I hereby give my consent for a qualified physician to perform any medical or surgical procedures s/he deems necessary to my welfare while participating in the Sponsored Event.
It is understood that Music for All and medical personnel will make every attempt to contact my emergency contact if I am unable to make determinations concerning my treatment. In the event they cannot be reached for an emergency, I hereby give permission to the physician selected by Music for All to secure and administer such treatment(s) as may be necessary, including hospitalization. I also authorize Music for All and its agents to release copies of my medical record to hospitals and other physicians to which they are referred and to insurance companies for payment of the medical claim. A photocopy of is as valid as the original. Further, this authorization permits said physician to hospitalize, secure appropriate consultation, order injections, anesthesia (local, general or both) or surgery for me if such emergency conditions warrant.
I hereby assume and agree to pay in indebtedness or physician’s or surgeon’s fees and hospital charges for such service, and for an ambulance or any other emergency transportation that may be needed.
I hereby irrevocably grant to Music for All, Inc., Bands of America, Orchestra America, and their respective agents, licensees, and assigns, the right to use in any and all media and in any and all forms my name, likeness, photographic prints, and any video or audio reproduction of sounds, performance, or appearances of me while attending the Sponsored Event, for any purpose including promotion, advertising, or otherwise.
I understand I will not be paid any royalty or other compensation. With the use of the rights, I hereby release Music for All, Inc. and its agents, licensees and assigns from all claims, liabilities and/or damages, which now or in the future may arise from such use.
I understand that consumption or possession of alcohol in the Ball State University residence halls is prohibited. I understand that a violation of this prohibition will result in the request for my departure from the residence halls. I, the undersigned, have read, understand and accept the “Late/Change Fees and Cancellation Policy” shown above.