Release form
May 18, 2024 10:18 PM
Acknowledgement of Risks & Hazards, Liability Release & Agreement Not To Sue for:
Dance Works Studio, its Owners, Directors and their Successors in Interest, Affiliates, Agents, Landowners, Instructors, Employees, Volunteers, and Insurers
PLEASE READ CAREFULLY BEFORE SIGNING, THIS IS A LEGAL DOCUMENT
Before being permitted to participate in Dance/Tumbling programs, please read the following and sign below agreeing to comply with this agreement
I hereby agree to release Michael & Mekesha Wanner, Dance Works Studio, and any other employees of affiliates of Dance Works Studio and hold them harmless of any and all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for and and all risks of injury resulting from participation in any dance classes at Dance Works Studio. I knowingly and voluntarily waive all rights and/or causes of action of any kind, including any and all claims of negligence, arising as a result of activity from which liability could accrue to Michael & Mekesha Wanner, Dance Works Studio, and any other employees or affiliates of Dance Works Studio.
I am aware that this is a release of liability and an acknowledgment of my voluntary and knowing assumption of risk of injury. I have signed this document voluntarily and of my own fee will in exchange for the privilege of participation. I hereby certify that I and/or my minor child are physically fit and have no medical conditions or allergies that affect the ability to participate in these activities.
If I am a minor, my parent and/or legal guardian has signed this document releasing Michael & Mekesha Wanner and Dance Works Studio and any other employees or affiliates of Dance Works Studio from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risk of injury inherent to these classes.
First Aid Release:
I authorize Dance Works Studio to administer first aid as they deem necessary. I authorize transportation to a medical facility, at my expense, if deemed necessary by Dance Works Studio’s teachers. I understand and accept that minor injuries may become life-threatening emergencies when far away from others or convenient facilities. Further, in the case of serious illness or injury, if I cannot be reached, I give permission for treatment, including medical and/or surgical care necessary for the well-being of myself or my child (hereafter, “minor participant”) at my expense. I understand that the teachers will, to the best of their ability attempt to notify me as soon as possible in the event of an emergency. I agree that upon transporting myself or my minor participant, to any medical facility, clinic or hospital, the responsibility of the teachers shall be totally fulfilled and Dance Works Studio shall have no further responsibility.
Photogenic Release:
I/We consent to the use by Dance Works Studio of any pictures (video and print) for commercial purposes, or otherwise, of me or my minor child in connection with the activities of Dance Works Studio, without restriction as to frequency, duration or medium.
Payment Terms:
All Tuition is due the first lesson of each month to pay for new session forward. You agree to pay all tuition covering classes for which your child is enrolled. No credit will be given for missed classes or nonattendance, except in cases of prolonged injury or illness. Accounts not current by the 10th of the month will be considered past due and a $15 late fee will be added to your bill. If the account is not current by the first lesson of the next month, your child will not be allowed to participate in classes until it is brought up to date. We accept cash or checks (made payable to Dance Works Studio).
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PARTICIPANT’S SIGNATURE DATE
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PARENT/GUARDIAN’S SIGNATURE (if under age 18) DATE