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WAIVER OF LIABILITY, INDEMNIFICATION, ASSUMPTION OF THE RISK, AUTHORIZATION TO CONTACT EMERGENCY MEDICAL ASSISTANCE and PUBLICITY RELEASE FORM (“Participant Agreement”)
In consideration for participation in one or more events held or sponsored by Kimiko Academy of Dance, LLC ( “Entity” or “Entities”), and the use of the property, facilities and services of the Entity and the facility at which the event is held (“Facility”), the above named participant and the participant’s parent, guardian or family (collectively the “Participant”), hereby acknowledges, accepts, fully understands, covenants and agrees to the following:
1. I freely acknowledge that I have, or will, voluntarily register myself/my child to participate in any/all activities held/sponsored by the Entity, which include but are not limited to, dance, acting, tumbling, limbering, exercise, gymnastics, acrobatics, contortion, stretching, etc. (collectively the “Activities”). I acknowledge that my/my child’s participation in the Activities entails both known, and unanticipated, risks that could result in serious and permanent physical and emotional injuries to myself/my child and others that include, but are not limited to myself/my child’s collision with people and/or stationary objects, damage, death, dismemberment, falls, injury or sickness, unavailability of emergency medical care, and/or the negligence and/or deliberate act of another person. I understand that such risks are inherent in the Activities and that even with precautions and safety measures they cannot be eliminated without jeopardizing the essential quality of the Activities. I also understand and acknowledge that injuries that I/my child receive(s) may be compounded or increased by negligent rescue operations. I understand that the Entity shall have no obligation to provide medical assistance in the event an injury occurs during the event. Understanding such dangers, I hereby knowingly and voluntarily enroll myself/my child in Activities held/sponsored by the Entity. I give permission for myself/my child to engage in the dangerous Activities described above, and I assume the risk of any and all Activities involving myself/my child. I understand that I do not/my child does not have permission to participate in the Activities at an event held/sponsored by the Entity without agreeing to the terms and conditions of this Participant Agreement. I acknowledge that this Participant Agreement applies, without limitation, to any other risks encountered before, during or after the Activities, whether or not the Participant knows or expects them to exist at the time of signing this Participant Agreement including, but not limited to, driving to or from the Activities, being present in any Facility at which the Activities are held and/or any other occurrence or event, known or unknown.
2. I represent that I/my child is in good physical, mental and emotional health and that no condition of mine/my child’s would constrain me/my child from safely participating in the Activities. I understand that failure to provide information of any health condition that would constrain me/my child from participating could result in serious injuries or death to me/my child. I agree to bear the costs of any injury or damages that I/my child may suffer while participating in any Activity/event held/sponsored by the Entity. I hereby authorize the Entity, or representatives of the Entity, to call for medical care for me/my child if medical attention is needed, obtain medical treatment for me/my child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make the Entity responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician.
3. Participant hereby knowingly and voluntarily releases and forever discharges the Entity and the owners, lessees, managers and licensees of the Facility, all of their respective employees, agents, coaches, instructors, assistants, officers, directors, owners, members, managers, shareholders, contractors and any other representative or affiliate, and their respective heirs, personal representatives, successors and assigns (collectively with the Entities, the “Entity Representatives”) from (1) any and all acts of active or passive negligence on the part of any one or all of the Entity Representatives, and (2) any and all liabilities, claims, causes of action, suits, controversies, judgments, demands, injuries, sickness, damages (consequential, incidental or otherwise), costs, expenses, attorneys’ fees, and any other legal, equitable or administrative actions or proceedings whatsoever, in tort, contract or otherwise, known or unknown, accrued or unaccrued, arising out of or related to the Activities, the Facility, the Participant, the Participant’s use of the Facility, the Participant’s involvement in the Activities, whether caused by negligence or otherwise, and any other matter or thing whatsoever arising out of or relating to this Participant Agreement, including without limitation, those based on death, physical injury, emotional injury and/or property damage (collectively “Losses”). Participant hereby agrees and shall indemnify, defend (with counsel acceptable to the Entity subject to liability) and hold each and every one of the Entity Representatives, jointly and severally, harmless from and against any and all Losses, including, but not limited to, any challenge by the Participant to this Participant Agreement or any provision hereof.
4. PUBLICITY RELEASE - PARTICIPANT HEREBY IRREVOCABLY GRANTS TO THE ENTITIES AND THOSE ACTING WITH THEIR AUTHORITY OR PERMISSION, THE UNRESTRICTED RIGHT TO COPYRIGHT AND USE, RE-USE, PUBLISH, REPUBLISH AND DISPLAY PHOTOGRAPHIC AND VIDEO IMAGES AND AUDIO OF THE PARTICIPANT OR IN WHICH THE PARTICIPANT MAY BE INCLUDED IN CONNECTION WITH ANY EVENT UNDERTAKEN BY ANY ENTITY, IN WHOLE OR IN PART, SEPARATELY OR IN CONJUNCTION WITH OTHER PHOTOGRAPHS OR VIDEO OR AUDIO, IN ANY MEDIUM NOW OR HEREAFTER KNOWN, AND FOR ANY PURPOSE WHATSOEVER, INCLUDING (BUT NOT BY WAY OF LIMITATION) ILLUSTRATION, ART, PROMOTION, ADVERTISING, TRADE AND/OR ANY OTHER PURPOSE WHATSOEVER, AND TO USE THE PARTICIPANT’S NAME IN CONNECTION THEREWITH. PARTICIPANT HEREBY FURTHER EXPRESSLY RELEASES AND WAIVES ANY DEMAND, ACTION, CLAIM, LICENSE, ROYALTY AND/OR ANY OTHER RIGHT TO ANY FORM OF PAYMENT THE PARTICIPANT MAY HAVE BASED ON CLAIMS AS TO THE RIGHTS OF PRIVACY, PUBLICITY, NOTORIETY AND/OR ANY OTHER RIGHTS ARISING OUT OF OR RELATING TO ANY USE BY ANY ENTITY OR THOSE ACTING WITH THEIR AUTHORITY OR PERMISSION OF THE UNDERSIGNED’S NAME, LIKENESS OR APPEARANCE.
5. PARTICIPANT EXPRESSLY AGREES THAT THE ASSUMPTION OF ALL RISKS, RELEASES, WAIVERS AND INDEMNIFICATION OBLIGATIONS CONTAINED HEREIN ARE INTENDED TO BE COMPLETE, UNCONDITIONAL AND AS BROAD AND INCLUSIVE AS PERMITTED BY THE LAWS OF INDIANA AND ANY OTHER JURISDICTION WHOSE LAWS APPLY TO THIS PARTICIPANT AGREEMENT. THIS PARTICIPANT AGREEMENT CANNOT BE AMENDED BY ANY ORAL STATEMENTS OR OTHER WRITINGS AND IS BINDING ON THE PARTICIPANT AND THE PARTICIPANT’S HEIRS, SUCCESSORS, DISTRIBUTEES, GUARDIANS, LEGAL REPRESENTATIVES, AND ASSIGNS. A FAXED, SCANNED OR ELECTRONIC SIGNATURE SHALL BE BINDING IN LIEU OF THE ORIGINAL. THIS PARTICIPANT AGREEMENT SHALL BE EFFECTIVE FOR A TEN (10) YEAR PERIOD FROM THE DATE OF SIGNATURE AND AUTOMATICALLY EXTENDED INDEFINITELY FOR ADDITIONAL TEN (10) YEAR PERIODS. PARTICIPANT WAIVES TRIAL BY JURY IN ANY ACTION OR PROCEEDING ARISING OUT OF, OR RELATED TO, THIS PARTICIPANT AGREEMENT.
By agreeing below, I certify that: (1) I acknowledge and have fully and completely read, accept, agree to and understand this Participant Agreement; (2) I am 18 years of age or older; (3) I am the parent/legal guardian of the Participant; (4) the information set forth above pertaining to the Participant is true and complete; and (5) I consent and agree to all of the foregoing on behalf of myself/my child/Participant.
Tuition and Payments
Fall classes are charged monthly on the 1st of the month and will have a one-time registration fee that is due upon registration. 3-8 week sessions and special events will be a one time charge and will NOT be charged monthly. Your account will be charged for these types of classes at the time of registration only. All other classes will default to monthly payments. We offer semi-annual (5% discount) and annual (8% discount) payments. If you would like to enrol in either of these payment programs instead of our automatic monthly payments, please contact our office to do so.
All student accounts at Kimiko are required to be enrolled in Automatic Payments. Please be sure to mark this option when you register for classes. All tuition payments will be deducted on the 1st of the month (or the next business day). These payments may include other existing charges on the account, including but not limited to, costume fees, registration fees, point of purchase charges, competition and convention fees (when applicable) etc. If you would like to pay another way, please be sure to make your payments before the first of the month via your preferred method of payment. If payment is not received prior to the first of the month, the card on file will be charged.
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