Consent to Participate, Payment Obligations and Policies
I hereby grant my consent for my daughter/son to participate in the program offered by 31Svn Street
Dance Academy. Class Tuition is due PRIOR to the start of each new session. TUITION Payments are non-refundable . Cash, Check, Visa, MasterCard and Discover are accepted forms of payment. NSF
checks will be charged a $35 fee.
On behalf of my Child, I, the parent or legal guardian agree to RELEASE
AND HOLD HARMLESS 31Svn Street Dance Academy, along with the officers, employees, instructors, volunteers,
successors, or assigns (hereinafter, “Representatives”) against any and all claims for injuries, damages, and losses of any
nature, whether known or unknown, including acts of negligence of 31Svn Street Dance Academy and its
Representatives, sustained by my Child which are in anyway related to his or her participation 31Svn Street Dance
Academy in Fishers, IN (hereinafter, “Premises”). I am fully aware of the risks, including potential personal
injuries, damages and losses, associated with participation in breakdancing, tumbling, gymnastics or any other
recreational, physical, and fitness-related activity at 31Svn Street Dance Academy (hereinafter, “Program”). I assume all
risks and accept full responsibility for any injuries, damages, and losses I may incur in connection with my decision to
participate in the Program at 31Svn Street Dance Academy. Furthermore, I confirm that my Child is in good health.
In consideration for my Child’s participation, I, on behalf of my Child, agree to the following:
1. Voluntary Participation: I understand and confirm that my participation in the Program at 31Svn Street Dance
Academy is voluntary.
2. Identification of Risks: I understand that as part of my Child’s participation in the Program there are dangers, hazards,
and inherent risks to which my Child may be exposed, including, but not limited to, the risk of serious physical injury,
temporary or permanent disability, and death, as well as economic and property loss. There may be other risks not known
to 31Svn Street Dance Academy and not reasonably foreseeable at this time. I understand that this Release of Liability and
Waiver is not intended to address all of the risks of any kind associated with my use of the Premises and my participation
in any aspect of the Program, including, particularly, such risks created by actions, inactions, or negligence on the part of
31Svn Street Dance Academy or its Representatives.
3. Assumption of Risk: I voluntarily assume all risks, known and unknown, foreseeable and unforeseeable, in any way
connected with my use of the Premises and my participation in the Program. I voluntarily accept personal responsibility
for any liability, injury, loss, or damage in any way connected with my use of the Premises and my participation in the
4. Release and Waiver: I hereby release and fully discharge 31Svn Street Dance Academy and its Representatives from
any and all claims or causes of action, including all liability for injury, loss, or damage, including Court costs and
attorneys’ fees, in any way connected with my use of the Premises and my participation in the Program, whether or not
caused in whole or in part by the negligence or other misconduct of 31Svn Street Dance Academy or its Representatives.
5. Indemnification: I agree to indemnify and reimburse 31Svn Street Dance Academy and its Representatives for any and
all claims for liability for injury, loss, damage, or expense, including reasonable attorneys’ fees (including the cost of
defending any claim that I might make, or that might be made on my behalf, that is released or waived by this instrument),
in any way connected with or arising out of my use of the Premises and my participation in the Program, whether or not
caused in whole or in part by the negligence or misconduct of 31Svn Street Dance Academy and any of its
6. Consent to Medical Treatment: In the event of an accident or serious illness, I authorize 31Svn Street Dance Academy
and its Representatives, to obtain medical treatment and transport for my Child on my behalf. I waive my right to receive
informed consent prior to such transportation or treatment. I further agree to accept full responsibility for any and all
expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her
participation in the Program. This consent does not impose a duty on 31Svn Street Dance Academy or its Representatives
to provide such assistance, transportation, or services.
7. Media and Photographic Image Release: I hereby agree that 31Svn Street Dance Academy shall have the right to record
my likeness or image through photograph or video and to the use of such materials on the website, Facebook page, print
communications, or for any other marketing purposes.
8. Severability: If any provision (or portion of any provision) of this Agreement is held to be invalid or unenforceable, that
provision shall be enforceable in part to the fullest extent permitted by law, and such invalidity or unenforceability shall
not otherwise affect any other provision of this instrument.
9. Applicable Law: This Agreement shall be governed, construed, and enforced in accordance with the law of the State of
10. This is a release of liability and waiver. I have read this release of liability, waiver, indemnification, and consent.
I understand and agree to all of the terms of this Agreement. I understand that I am giving up substantial rights
(including my right to sue) and acknowledge that I am willingly signing this document. My signature on this
document is intended to bind not only myself and my Child, but also the successors, heirs, representatives,
administrators, and assigns of myself and my child.
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