I hereby release Wellspring/Cori Terry & Dancers as well as any and all municipal, government, or personnel whose properties or services are used and any or all sponsor(s), company(s), agency(s), or individual(s) from responsibility for any injuries or damages that I, my company or my students suffer as a result of participation in Wellspring’s Midwest Regional Alternative Dance Festival. I will additionally permit my name and picture to be used in any broadcasts, telecasts, marketing materials, or any media for promotional purposes. I also understand that the entry fee is non-refundable. I submit that the choreography/improvisation is original and created by the choreographer/improvisor whose name is submitted and that all information on this form is true and complete. I have read the entry information provided and certify by my initials my compliance.