Liability exemption form Bloc Audition 2018

Liability exemption form

Please read carefully, fill and sign the present liability exemption form in order to enter the Bloc Audition. It won't be possible to be viewed by Bloc Talent Agent without this form signed before.
ART.1 – EXONERATING CONSENT OF PERSON ENTITLED

The Organization is exempted from any kind of liability. Any kind of personal injury or damage that may occur during Bloc Audition has to be considered covered by the exonerating consent of person entitled, which relieves the organization from any kind of responsibility in this regard. Signing this release form, I accept all conditions and I formally give consent in terms.

ART.2 – WAIVER OF RESPONSIBILITY FOR THINGS OR VALUES OF PARTICIPANTS AT THE EVENT

With the express exclusion of the applicability of Articles 1789 et seq. Cc the organization is not responsible for loss, theft or damage of property, personal effects and values of participants brought in the building where the event is organized.

ART.3 – DECLARATION OF POSSESSION OF MEDICAL CERTIFICATE

The undersigned also declares to be in possession of medical certificate attesting the ability to perform physical activity referred to above (certificate of good health).
PARTECIPANT'S DATA
Dancer's name*

NameSurname
Birth date*

MeseGiornoAnno
Address*

Street

Street Address Line 2

City

Zip codeCountry
Phone number*

Int. code (for ex +39)number
E-mail*
example@example.com
PARENT/GUARDIAN ADULT’S DATA

(Just for minors)
Name

NameSurname
Phone number

Int. codenumber
E-mail
example@example.com
In case of emergency
Person to be contacted*

NameSurname
Degree of kinship*
Phone number*

Int. codeNumber
I DECLARE

I have read information regarding this liability waiver made pursuant to art. 1-3 of the Decree. N . 196/03

CONSENT FOR PERSONAL DATA PROCESSING

The undersigned agrees to Personal Data Processing for the completion of all the instrumental activities to the realization of the institutional purpose including the diffusion, either via press and television, of all information relating to the competition and its outcomes. I also agree to the Treatment and Publication for institutional goals, of photographs and images designed to reveal the undersigned’s identity on the website of the Institution.

CONSENT TO SENSITIVE DATA

The undersigned, acquired the information under Article 13 of Legislative Decree no . No 196/2003, consent to the processing of its personal data, declaring to have been aware that these data fall into the category of "sensitive data " in Article 4 paragraph 1 letter . d ) and Art. 26 of Legislative Decree no . 196/2003, that means personal data disclosing health status.

CONSENT TO THE PROCESSING OF PERSONAL DATA FOR MARKETING PURPOSE

I also express consent to the communication of data and to the use of image for marketing and promotional activities to third parties with whom the institution is in contractual relations, treated by these to the extent necessary to fulfil the obligations under the law and by contracts.
I GIVE CONSENT

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
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