SDO Additional Information & Medical Form

SDO Additional Information & Medical Form

  • MM slash DD slash YYYY
  • Medical Information

    By submitting this form, the undersigned, being (1) a participant of LIGHT OF THE WORLD MINISTRIES and (2) the parent or guardian of the person participating in LIGHT OF THE WORLD MINISTRIES, hereby represent, consent and agree to the following: 1) Those participating in LIGHT OF THE WORLD MINISTRIES Summer Dance functions are participating of their own free will. 2) We are aware of and voluntarily assume all of the risks of the activities during the aforementioned time and functions of LIGHT OF THE WORLD MINISTRIES including the risks of any illness and/or injuries which might result there from. 3) We are covered by medical insurance with an insurance company which covers the costs of medical treatment which may be incurred for any illness and/or injuries which might result from the individual's participation in the functions of LIGHT OF THE WORLD MINISTRIES. 4) We, the undersigned, hereby agree to hold LIGHT OF THE WORLD MINISTRIES harmless from any illness and/or injuries, claims for illness and/or injuries, or legal action for claims for illness and/or injuries arising out of the aforementioned functions. 5) In this regard, we the undersigned hereby agree to present any medical bills arising out of the cost for treatment for any illness and/or injuries which occurred during the aforementioned functions to our insurance company for payment.
  • Please make sure to use someone other than your mother or father!
  • Photo/Video Release

    Dear Student and Parent: We often update our website and promotional materials and may use some pictures and video footage from previous workshops. Pictures and video footage may be used in future brochures and other publications representing classroom and general workshop settings. Photos and videography would never be intentionally used in such a way to reflect negatively on their subjects. Please read and sign the release below.