Consent&Waiver

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CONSENT, WAIVER AND RELEASE The undersigned parent/guardian give permission to my son/daughter ___________________________ to participate in a travel tour organized

by Pantuso Dance, a division of 0832774 BC Ltd. (Pantuso), from Courtenay to Nanaimo and back on Saturday February 16, 2013. I authorize the chaperones to act on my behalf for my son/daughter in any emergency, on the understanding that I will be contacted as soon as possible in the event of such an emergency. I agree to waive any and all claims that have or may in the future have against Pantuso, Lindsay Sterk or the chaperone or any one or more of them (collectively the Chaperones) arising from the aforesaid travel tour, and to release the Chaperones from any and all liability for any loss, damage, expense or injury that may be suffered by my son/daughter on the said travel tour. Dated this _____________day of February, 2013.

_____________________________________________ Signature of Parent/Guardian

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