DANCE FOR PD®    ~   Registration,  Waiver, and Release


Our Sessions at PNB, Garfield, AND on Zoom have concluded for the summer. We are looking to resume in October. Check out our website here for updates!

*Join us on September 10th for a free community class led by Shawn Roberts and other teaching artist's during our professional development training weekend! 
Participant Information








Emergency Contact



For funding purposes, please complete the following: (data will remain anonymous)







Waivers

Liability

I recognize that risk of illness and/or injury may be inherent in any dance or exercise class; however, the above identified individual is participating with the express agreement of, and understanding that Seattle Theatre Group, Northwest Parkinson’s Foundation, Dance for PD®, Mark Morris Dance Group, and Pacific Northwest Ballet-Francia Russell Center, and its directors, officers, employees, partners and agents are hereby released from any and all claims, costs, liabilities, expenses, or judgments associated with this Dance for Parkinson’s program. I hereby execute and deliver this Waiver and Release form to induce SEATTLE DANCE FOR PD® PARTNERS to permit the above identified student to participate in the Dance for Parkinson’s in the 2021-2022 year.

 

I hereby understand that SEATTLE DANCE FOR PD® PARTNERS may take photographs and/or video of the participants enrolled on this form, and I authorize SEATTLE DANCE FOR PD® PARTNERS to use these photographs and video for archival and marketing purposes via brochures, website, and social media. 

I hereby grant the SEATTLE DANCE FOR PD® PARTNERS staff permission to administer first aid and/or call 911 in the case of a medical emergency while I attend classes. I realize and understand that SEATTLE DANCE FOR PD® PARTNERS staff will attempt to notify emergency contacts in case of an emergency.


In Witness Whereof, I have executed this waiver and release.



COVID-19 TESTING CONSENT FOR STG EDUCATION AND COMMUNITY ENGAGEMENT  

 

Seattle Theatre Group (STG) Education and Community Engagements (ECE) takes health & safety as a high priority. By agreeing to participate in our programs you are agreeing to follow STG’s safety protocols:     

 

Seattle Theatre Group reserves the right to conduct COVID-19 rapid testing throughout the program as needed in an effort to protect the health, safety and welfare of participants. This testing is being conducted, to the extent these tests continue to be made available by Seattle Theatre Group and will be provided at no cost to you.  

 

COVID-19 Testing Information: The test that would be administered to you/ your student would be a rapid-antigen test. This test has been approved by the FDA under an emergency use authorization and involves the swabbing of you or your/ your child’s nasal passage in order to obtain a sample for testing. There are risks and benefits with undergoing a diagnostic test for COVID-19 and there may be a potential for false positive or false negative test results. Additionally, the actual test may cause slight discomfort to your/your child’s nose or throat during the collection process and for a short period of time thereafter. You will be provided with the results of your test, and it will be your responsibility to seek advice and treatment from your medical provider if necessary. You/your child will receive an FDA authorized or approved antigen test to mitigate transmission of the virus. Testing may happen once a week or more often, as determined necessary by Seattle Theatre Group.   

 

Testing can happen upon arrival to STG’s program and will be overseen by STG’s COVID Officer. If an individual tests positive with the antigen test, you/your child will be sent home. You may return to the program one-week after, at which point, you will need to provide a negative result from an antigen test administered on site, for free by an STG COVID Officer.   

 

Reporting of test results will be done in a confidential manner consistent with state, city and federal regulations. Notification of exposed individuals shall occur in a way as to protect the confidentiality of the person with COVID-19 and in accordance with statutory confidentiality requirements. Should there be a positive result, STG will be immediately informed in a manner consistent with legal confidentially requirements.  

 

Masking will be optional, subject to change as needed. 

 

By your signature below, you certify that you have read and understood this COVID-19 Testing Consent. More specifically, by signing below you:    

(1) Give your permission for you/ your child to be tested for COVID-19  

(2)  Understand that it is your responsibility to seek advice and treatment from your medical provider, if necessary  

(3) Understand that information regarding test results may be disclosed as allowed by applicable law  

(4) Understand that this testing may occur at multiple points throughout program 

(5) Understand that you/your child will be sent home if positive COVID-19 results are confirmed  

(6) You agree to indemnify, save, and hold STG, its affiliates, contractors, employees, agents and its partners, licensors, and suppliers harmless from any claims, losses, damages, liabilities, including legal fees and expenses, arising out of your use or misuse of the site and/or the materials, or any breach of the representations, warranties, and covenants made by you herein. 






Contact Information