WAIVER AND RELEASE OF LIABILITY
In consideration of the risk of injury while participating in dance classes (the "Activity"), and as
consideration for the right to participate in the Activity, I hereby, for myself, my heirs,
executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter
into this waiver and release of liability and hereby waive any and all rights, claims or causes of
action of any kind whatsoever arising out of my participation in the Activity, and do hereby
release and forever discharge K.O.M. Dance Inc., located at 14965 Old Saint Augustine Rd Unit
132, Jacksonville, Florida 32258, their affiliates, managers, members, agents, attorneys, staff,
volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or
psychological injury, including but not limited to illness, paralysis, death, damages, economical or
emotional loss, that I may suffer as a direct result of my participation in the aforementioned
Activity, including traveling to and from an event related to this Activity.
I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM
PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE
RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN
THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR
PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY
OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL
LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE
FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE
CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED
RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY,
INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.
I agree to indemnify and hold harmless K.O.M. Dance Inc. against any and all claims, suits or
actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me
or anyone on my behalf, including attorney's fees and any related costs, if litigation arises
pursuant to any claims made by me or by anyone else acting on my behalf. If K.O.M. Dance Inc.
incurs any of these types of expenses, I agree to reimburse K.O.M. Dance Inc..
I acknowledge that K.O.M. Dance Inc. and their directors, officers, volunteers, representatives
and agents are not responsible for errors, omissions, acts or failures to act of any party or entity
conducting a specific event or activity on behalf of K.O.M. Dance Inc..
I ACKNOWLEDGE THAT THIS ACTIVITY MAY INVOLVE A TEST OF A PERSON'S
PHYSICAL AND MENTAL LIMITS AND MAY CARRY WITH IT THE POTENTIAL FOR DEATH,
SERIOUS INJURY, AND PROPERTY LOSS. The risks may include, but are not limited to, those
caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants,
equipment, vehicular traffic and actions of others, including but not limited to, participants,
volunteers, spectators, coaches, event officials and event monitors, and/or producers of the
event.
I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND
FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO
RELEASE AND DISCHARGE K.O.M. Dance Inc. AND ALL OF ITS AFFILIATES, MANAGERS,
MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES,
PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR
CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT
THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST K.O.M. Dance Inc. FOR
PERSONAL INJURY OR PROPERTY DAMAGE.
To the extent that statute or case law does not prohibit releases for negligence, this release is
also for negligence on the part of K.O.M. Dance Inc., its agents, and employees.
In the event that I should require medical care or treatment, I agree to be financially responsible
for any costs incurred as a result of such treatment. I am aware and understand that I should
carry my own health insurance.
In the event that any damage to equipment or facilities occurs as a result of my or my family's
willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all
costs associated with any actions of neglect or recklessness.
This Agreement was entered into at arm's-length, without duress or coercion, and is to be
interpreted as an agreement between two parties of equal bargaining strength. Both the
Participant, __________________________, and K.O.M. Dance Inc. agree that this Agreement is
clear and unambiguous as to its terms, and that no other evidence will be used or admitted to
alter or explain the terms of this Agreement, but that it will be interpreted based on the language
in accordance with the purposes for which it is entered into.
In the event that any provision contained within this Release of Liability shall be deemed to be
severable or invalid, or if any term, condition, phrase or portion of this agreement shall be
determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall
remain in full force and effect, so long as the clause severed does not affect the intent of the
parties. If a court should find that any provision of this agreement to be invalid or unenforceable,
but that by limiting said provision it would become valid and enforceable, then said provision shall
be deemed to be written, construed and enforced as so limited.
In the event of an emergency, please contact the following person(s) in the order presented:
Emergency Contact Contact Relationship Contact Telephone
I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely
signing this agreement. I certify that I have read this agreement, that I fully understand its content
and that this release cannot be modified orally. I am aware that this is a release of liability and a
contract and that I am signing it of my own free will.
Participant's Name:
Participant's Address:
Signature:
