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Permission Slip for the 2016-2017 Dance Year My child/children __________________________________________________________ has/have my permission to participate in the Byzantio dance program. I indemnify the directors of the dance program and Saints Katherine Greek Orthodox Church from any liability or hazard that may arise from but not limited to dance practice, performances, or transportation. I authorize the Byzantio Greek Dance and Cultural Arts Program to use my child’s likeness on the web, social media, or still photograph production that will be produced by and available to the public from the Program. The Byzantio Greek Dance and Cultural Arts Program is not responsible for and cannot control the use of a child’s likeness on the web, social media, or still photography produced by others. I __________________________________ have read and understand the Byzantio Greek Dance and Cultural Arts Program Bylaws and agree to abide by them. I will insist that my children abide by the Bylaws as well. I also understand that these bylaws may be amended by the executive committee as needed. __________________________________________________________________________________________ HEALTH INSURANCE AND ASSOCIATED INFORMATION Name of Insurance Company ____________________________________________ Policy #______________________________ Phone ____________________ Emergency Contact ____________________________________________________ Home: ______________________ Cell: ______________________ Health Problems and Medications Taken: __________________________________________________________________________________________ Parent Signature: __________________________________ Date: __________________