Common use of CONSENT FOR EMERGENCY MEDICAL TREATMENT Clause in Contracts

CONSENT FOR EMERGENCY MEDICAL TREATMENT. In cases of emergency, the Shenandoah Academy of Dance is authorized to arrange for medical services for the student and I consent to appropriate medical and surgical service recommended by licensed medical pro- fessionals. I accept full responsibility for all costs of said medical care and any emergency treatments. The Shenandoah Academy of Dance will not be responsible for the cost of any medical care or emergency treat- ments. I hereby waive all claims whatsoever in connection with such medical treatments. I agree that Shenan- doah Academy of Dance including its instructors will not be held liable for and agree to hold Shenandoah Academy of Dance including its instructors harmless from any and all liabilities, losses, damages or expenses related to the student’s participation in any activities at Shenandoah Academy of Dance. I have read and agree to the 2020 – 2021 Consent for Emergency Treatment. Signed: Parent / Legal Guardian / Adult Student Payor Date: I have read the above waiver and sign it voluntarily. I agree to adhere to these policies to ensure the safety of my children and the integrity and professional atmosphere of the Shenandoah Academy of Dance. I, (Xxxxxx’s/Guardian’s Name), hereby represent to the Shenandoah Academy of Dance that my child is of sound health and has no history of a medical or physical condition which could in any shape, manner or form place my child at risk because of said condition. I acknowledge that I have been informed by the Shenandoah Academy of Dance of the nature of the instruction my child will receive and that such instruction involves physical exercise, exertion and stress, which could result in injury and /or disability. Name of Student: Date: Printed Name of Parent/Guardian: Address of Parent/Guardian: Signature of Parent: Cell Phone #: Home Phone #: E-mail Address: Any medical conditions or allergies we should be aware of? No Please Explain: Yes New policy additions Adapted for the 2019—2020 Season Stealing / Lying and other serious student misconduct: Stealing on any Shenandoah Academy of Dance or Shenandoah Ballet venue (including but not limited to: the studio or any performance venue), is grounds for dismissal. I am in the position of not just teach- ing ballet steps for my students. It is also my job to instill in my students a sense of community and be- longing as well as integrity, ethics and strong moral fortitude. I will NOT tolerate stealing. (Intl) Lying and other verbally disparaging remarks about other students, teachers or any other Shenan- doah Academy of Dance / Shenandoah Ballet volunteers, staff or patrons is also not to be tolerated. This includes social media. There is to be no cursing or other foul language used in my studios or any other venue that the Shenandoah Academy of Dance or Shenandoah Ballet occupies. I am promoting a healthy, safe and nurturing environment for all young (and young-at-heart) students to enjoy and thrive in. Word travels fast in a small studio so please make sure that your students understand that only re- spectful behaviors will be allowed. (Intl) Teachers’ Responsibilities in the Classroom: If there are problems in the studio that relate to other students, please bring them to me not the teacher. Teachers are paid to teach class and having discus- sions with teachers prior to class prevents them from doing so. This not only disrupts their focus, it also disrupts the students’ focus, prevents teachers from starting class on time which affects other parents’ paid tuition. It is absolutely necessary to bring any issues to my attention via email if I am teaching or starting class. Please let my teachers do what they are there to do … teach class. Again, xxxxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx (Intl) 2020 - 2021 Studio Rules / Guidelines

CONSENT FOR EMERGENCY MEDICAL TREATMENT. In cases the event of emergencyillness or injury, the Shenandoah Academy of Dance is authorized we hereby authorize University employees to arrange obtain emergency or other medical treatment for medical services for the student as deemed medically necessary, and I consent to appropriate medical and surgical service recommended by licensed medical pro- fessionals. I accept full responsibility for all costs of said medical care and any emergency treatments. The Shenandoah Academy of Dance will not be responsible for we hereby assume the cost of such treatment. We understand that this authorization is given in advance of any medical specific diagnosis, treatment, or hospital care or emergency treat- mentsbeing required, but is given to provide authority and power on the part judgment of a licensed physician is deemed advisable. I hereby waive all claims whatsoever in connection with such medical treatments. I agree that Shenan- doah Academy A copy of Dance including its instructors will not be held liable for this Agreement, Release and agree to hold Shenandoah Academy of Dance including its instructors harmless from any and all liabilities, losses, damages or expenses related to the student’s participation in any activities at Shenandoah Academy of Dance. I have read and agree to the 2020 – 2021 Consent for Emergency Medical Treatment shall have the same force and effect as the original. If the student is a minor (younger than 18), a parent or legal guardian must also sign this High School Student Laboratory Worker Agreement, Release and Consent for Emergency Medical Treatment, and all references to “we” and similar terms shall be read to include both the parent/guardian and the student. Signed: Parent / Legal Guardian / Adult Student Payor This release and agreement is binding on myself, my heirs, assigns, and personal representatives. Date: I have read the above waiver and sign it voluntarily. I agree to adhere to these policies to ensure the safety of my children and the integrity and professional atmosphere of the Shenandoah Academy of Dance. I, (Xxxxxx’s/Guardian’s Student Printed Name), hereby represent to the Shenandoah Academy of Dance that my child is of sound health and has no history of a medical or physical condition which could in any shape, manner or form place my child at risk because of said condition. I acknowledge that I have been informed by the Shenandoah Academy of Dance of the nature of the instruction my child will receive and that such instruction involves physical exercise, exertion and stress, which could result in injury and /or disability. Name of Student: Student Signature: Date: Printed Name of Parent/GuardianGuardian Printed Name: Address of Parent/GuardianGuardian Signature: Signature NCCU HIGH SCHOOL STUDENT LABORATORIAN TRAINING RECORD‌ Work with PI to submit completed form to xxx@xxxx.xxx within the first 5 days as a laboratorian Name Email Start Date End Date Principal Investigator PI Email I HAVE BEEN TRAINED ON THE FOLLOWING LAB SPECIFIC SAFETY ITEMS Emergency evacuation routes and indoor and outdoor emergency assembly points Yes No Location of Parent: Cell Phone #: Home Phone #: Esafety showers and eyewash stations Yes No Location of fire extinguishers and closest fire alarm pull station Yes No Location of first aid kit Yes No Location of all laboratory spill kits (chemical and biological if applicable) Yes No How to access to safety data sheets (SDS) Yes No Emergency shutoffs for laboratory equipment Yes Environmental Health and Safety No N/A I have received training on the required PPE for lab, including use and limitations Yes No N/A Laboratory hazardous waste management protocols Yes No N/A I am familiar with the location and have reviewed any applicable Plans and Manuals NCCU Laboratory Safety Manual Yes Lab-mail Address: Any medical conditions or allergies we should be aware of? Specific Laboratory Safety Plan Yes NCCU Chemical Safety and Chemical Hygiene Plans Yes No Please Explain: N/A NCCU Exposure Control Plan (Bloodborne Pathogens) Yes New policy additions Adapted No N/A NCCU Biosafety Manual Yes No N/A Environmental Health and Safety I HAVE COMPLETED THE REQUIRED TRAINING AND PASSED THE QUIZ WITH A SCORE OF 80% OR GREATER Orientation for the 2019—2020 Season Stealing / Lying and other serious student misconduct: Stealing on any Shenandoah Academy of Dance or Shenandoah Ballet venue (including but not limited to: the studio or any performance venue), is grounds for dismissal. I am in the position of not just teach- ing ballet steps for my students. It is also my job to instill in my students a sense of community and be- longing as well as integrity, ethics and strong moral fortitude. I will NOT tolerate stealing. (Intl) Lying and other verbally disparaging remarks about other students, teachers or any other Shenan- doah Academy of Dance / Shenandoah Ballet volunteers, staff or patrons is also not to be tolerated. This includes social media. There is to be no cursing or other foul language used in my studios or any other venue that the Shenandoah Academy of Dance or Shenandoah Ballet occupies. I am promoting a healthy, safe and nurturing laboratory environment for all young (and young-at-heart) students to enjoy and thrive in. Word travels fast in a small studio so please make sure that your students understand that only re- spectful behaviors will be allowed. (Intl) Teachers’ Responsibilities in the ClassroomHigh School Student Laboratorians Yes No N/A Date: If there are problems in the studio that relate to other students, please bring them to me not the teacher. Teachers are paid to teach class and having discus- sions with teachers prior to class prevents them from doing so. This not only disrupts their focus, it also disrupts the students’ focus, prevents teachers from starting class on time which affects other parents’ paid tuition. It is absolutely necessary to bring any issues to my attention via email if I am teaching or starting class. Please let my teachers do what they are there to do … teach class. Again, xxxxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx (Intl) 2020 - 2021 Studio Rules / GuidelinesStudent Laboratorian Printed Name: Student Laboratorian Signature:

CONSENT FOR EMERGENCY MEDICAL TREATMENT. In cases of emergency, the Shenandoah Academy of Dance is authorized to arrange for medical services for the student and I consent to appropriate medical and surgical service recommended by licensed medical pro- fessionals. I accept full responsibility for all costs of said medical care and any emergency treatments. The Shenandoah Academy of Dance will not be responsible for the cost of any medical care or emergency treat- ments. I hereby waive all claims whatsoever in connection with such medical treatments. I agree that Shenan- doah Academy of Dance including its instructors will not be held liable for and agree to hold Shenandoah Academy of Dance including its instructors harmless from any and all liabilities, losses, damages or expenses related to the student’s participation in any activities at Shenandoah Academy of Dance. I have read and agree to the 2020 – 2021 2016-17 Consent for Emergency Treatment. Signed: Parent / Legal Guardian / Adult Student Payor Date: I have read the above waiver and sign it voluntarily. I agree to adhere to these policies to ensure the safety of my children and the integrity and professional atmosphere of the Shenandoah Academy of Dance. I, (Xxxxxx’s/Guardian’s Name), hereby represent to the Shenandoah Academy of Dance that my child is of sound health and has no history of a medical or physical condition which could in any shape, manner or form place my child at risk because of said condition. I acknowledge that I have been informed by the Shenandoah Academy of Dance of the nature of the instruction my child will receive and that such instruction involves physical exercise, exertion and stress, which could result in injury and /or disability. Name of Student: Date: Printed Name of Parent/Guardian: Address of Parent/Guardian: Signature of Parent: Cell Phone #: Home Phone #: E-mail Address: Any medical conditions or allergies we should be aware of? No Please Explain: Yes New policy additions Adapted for the 2019—2020 Season Stealing / Lying and other serious student misconduct: Stealing on any Shenandoah Academy of Dance or Shenandoah Ballet venue (including but not limited to: the studio or any performance venue), is grounds for dismissal. I am in the position of not just teach- ing ballet steps for my students. It is also my job to instill in my students a sense of community and be- longing as well as integrity, ethics and strong moral fortitude. I will NOT tolerate stealing. (Intl) Lying and other verbally disparaging remarks about other students, teachers or any other Shenan- doah Academy of Dance / Shenandoah Ballet volunteers, staff or patrons is also not to be tolerated. This includes social media. There is to be no cursing or other foul language used in my studios or any other venue that the Shenandoah Academy of Dance or Shenandoah Ballet occupies. I am promoting a healthy, safe and nurturing environment for all young (and young-at-heart) students to enjoy and thrive in. Word travels fast in a small studio so please make sure that your students understand that only re- spectful behaviors will be allowed. (Intl) Teachers’ Responsibilities in the Classroom: If there are problems in the studio that relate to other students, please bring them to me not the teacher. Teachers are paid to teach class and having discus- sions with teachers prior to class prevents them from doing so. This not only disrupts their focus, it also disrupts the students’ focus, prevents teachers from starting class on time which affects other parents’ paid tuition. It is absolutely necessary to bring any issues to my attention via email if I am teaching or starting class. Please let my teachers do what they are there to do … teach class. Again, xxxxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx (Intl) 2020 - 2021 Studio Rules / Guidelines:

CONSENT FOR EMERGENCY MEDICAL TREATMENT. In cases of emergency, the Shenandoah Academy of Dance is authorized to arrange for medical services for the student and I consent to appropriate medical and surgical service recommended by licensed medical pro- fessionals. I accept full responsibility for all costs of said medical care and any emergency treatments. The Shenandoah Academy of Dance will not be responsible for the cost of any medical care or emergency treat- ments. I hereby waive all claims whatsoever in connection with such medical treatments. I agree that Shenan- doah Academy of Dance including its instructors will not be held liable for and agree to hold Shenandoah Academy of Dance including its instructors harmless from any and all liabilities, losses, damages or expenses related to the student’s participation in any activities at Shenandoah Academy of Dance. I have read and agree to the 2019 – 2020 – 2021 Consent for Emergency Treatment. Signed: Parent / Legal Guardian / Adult Student Payor Date: I have read the above waiver and sign it voluntarily. I agree to adhere to these policies to ensure the safety of my children and the integrity and professional atmosphere of the Shenandoah Academy of Dance. I, (Xxxxxx’s/Guardian’s Name), hereby represent to the Shenandoah Academy of Dance that my child is of sound health and has no history of a medical or physical condition which could in any shape, manner or form place my child at risk because of said condition. I acknowledge that I have been informed by the Shenandoah Academy of Dance of the nature of the instruction my child will receive and that such instruction involves physical exercise, exertion and stress, which could result in injury and /or disability. Name of Student: Date: Printed Name of Parent/Guardian: Address of Parent/Guardian: Signature of Parent: Cell Phone #: Home Phone #: E-mail Address: Any medical conditions or allergies we should be aware of? No Please Explain: Yes New policy additions Adapted for the 2019—2020 Season Stealing / Lying and other serious student misconduct: Stealing on any Shenandoah Academy of Dance or Shenandoah Ballet venue (including but not limited to: the studio or any performance venue), is grounds for dismissal. I am in the position of not just teach- ing ballet steps for my students. It is also my job to instill in my students a sense of community and be- longing as well as integrity, ethics and strong moral fortitude. I will NOT tolerate stealing. (Intl) Lying and other verbally disparaging remarks about other students, teachers or any other Shenan- doah Academy of Dance / Shenandoah Ballet volunteers, staff or patrons is also not to be tolerated. This includes social media. There is to be no cursing or other foul language used in my studios or any other venue that the Shenandoah Academy of Dance or Shenandoah Ballet occupies. I am promoting a healthy, safe and nurturing environment for all young (and young-at-heart) students to enjoy and thrive in. Word travels fast in a small studio so please make sure that your students understand that only re- spectful behaviors will be allowed. (Intl) Teachers’ Responsibilities in the Classroom: If there are problems in the studio that relate to other students, please bring them to me not the teacher. Teachers are paid to teach class and having discus- sions with teachers prior to class prevents them from doing so. This not only disrupts their focus, it also disrupts the students’ focus, prevents teachers from starting class on time which affects other parents’ paid tuition. It is absolutely necessary to bring any issues to my attention via email if I am teaching or starting class. Please let my teachers do what they are there to do … teach class. Again, xxxxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx (Intl) 2020 - 2021 Studio Rules / Guidelines.