Engagement Consent Form: Dance Activity

CSU Dance Engagement Form — General Use

This form registers you, or your child, as a participant in one of Colorado State University’s Dance Engagement Activities. These activities are facilitated by current CSU students, faculty, staff, and/or invited guest artists and involve group or one-on-one virtual contact. Participants are asked to follow along with age-appropriate dance movements, create and perform their own dance movements, view and respond to live/recorded dance performances, and to ask and reply to questions related to content. As with any physical activity beyond day-to-day actions, there is a potential risk of bodily injury, death or damage to property. As with all exercise programs, all participants should listen to their bodies. To reduce and avoid injury, all participants should check with their doctor before beginning any movement activities included. By performing any fitness/dance exercises, you are performing them at your own risk. Risks of online activity include, but are not limited to, data mining, phishing, viruses, malware, data breach of online information, cyber predators, cyberbullying, and image replication.

Activity*
First Name*
Last Name*
Email*
Emergency Contact Telephone Number:*
Name of health insurance carrier:*
Policy number:*
Street Address*
City*
State*
Zip*
Current age*
Parent/Guardian Name (if under 18 years of age):
Parent/Guardian Email (If under 18 years of age):
I understand, accept, and assume all such hazards and risks, and waive all claims against the State of Colorado, The Board of Governors of the Colorado State University System, and Colorado State University, and other persons as facilitating this event, including students, faculty, staff, and/or invited guest artists.*
- I agree to the above
Media Recording*
- I agree to give media recording consent as outlined below
CSU may record participants’ appearance on video, audio, photography, or other media and may use participants’ names, likeness, and/or voice in connection with these recordings. CSU may use, reproduce, distribute, publicly display and/or perform these recordings, either electronically or by any other media, whether now known, or hereafter existing. CSU may allow others to do the same for any purpose related to CSU’s mission, including without limitation, promotional or educational. I give my consent for CSU to publish, republish or otherwise transmit the images of myself, or my child, in any media for all purposes. I understand the images may be altered or modified and that recordings shall be the property of Colorado State University. I authorize the use of these materials indefinitely without compensation to me.