Date _____ Group-leader signature _____

By c ompleting and signing this I give my consent to use of personal data.

Name ___________________________________Surname _____________________________________

Born to __________________________________________________ date of birth ___________________

Address _______________________________________________________________________________

Zip code _______________ city __________________________________ state _____________________

Phones ____________________________e-mail______________________________________________

I request to become a member of Calabria Arte Association of Reggio Calabria- Italy and ask to participate at

the cultural activities in program year 2012 included the Mediterraneo Dance Festival to be held in Reggio

Calabria from 4 to 31 July 2012.

I certify that the undersigned has been subjected to a medical examination over the 12 months preceding the

date of the event and that the undersigned is healthy with no physical impairments.

I declare that I grant Calabria Arte association of Reggio Calabria full permission to use, without

compensation any images, photos and video recordings, that the organization wil make during the event

for advertising, promotions and commercial activities.

I declare that I am aware and accept the general conditions of participation, absolving the organization of

the event from any civil or criminal liability, directly or indirectly related to such participation, for damages to

persons or property

By c ompleting and signing this I give my consent to use of personal data.

Date_____________________ Signature ______________________________________

Name ____________________________________ Surname ___________________________________

Born to _____________________________________________ date of birth ________________________

Address ______________________________________________________________________________

Zip code _______________ city ___________________________________ state ___________________

Phones ___________________________ e-mail______________________________________________

parent/guardian of the child, name _________________________ surname ________________________

date of birth _ ________________ address__________________________________________________

zip code ______________ city _______________________________________ state ________________

phones ________________________________ e-mail _________________________________________

I request for my child to become a member of Calabria Arte Association of Reggio Calabria- Italy and ask to

participate at the cultural activities in program year 2012 included the Mediterranean Dance Festival to be

held in Reggio Calabria from 4 to 31 July 2012.

I authorize my child to participate to Mediterraneo Dance Festival to be held at the Reggio Calabria - Italy

from July 4 – 31, 2012, Discharging Calabria Arte association from any responsibility regarding the

participation, residence and custody of the child, and hereby grant Calabria Arte full permission to use,

without compensation, images, photos and video recordings of my son/daughter which the organization will

make during the event for advertising, promotional and commercial activities.

I certify that my child has been subjected to a medical examination over the 12 months preceding the date of

the event and that he/she is healthy with no physical impairments.

I declare that I am aware and accept the general conditions of participation, absolving the organization of the

event from any civil or criminal liability, directly or indirectly related to such participation, for damages to

persons or property.

By c ompleting and signing this I give my consent to use of personal data.

Date _________________ Signature of the parent or guardian _______________________________

mediterrane o DANCE festival 2012

Name of the School – Group _______________________________________________________________

Name and Surname Soloist _________________________________________________________________

Choreograph / Leader _____________________________________________________________________

Phones _____________________________Email _______________________________________________

Дата добавления: 2015-11-14