Medical Release Waiver/Assumption of Risk
I certify that I am the parent/legal guardian of and give my child
my permission for her/him to participate in dance, tumbling, playground activities, workouts or any other activities on premise (the
“Activity”),. In addition, I authorize Chavarria Institute of the Arts to provide emergency medical treatment to my child in my absence
when a reasonable effort has been made to contact me. If deemed necessary, 911 will be contacted and fire- paramedics dispatched
to the scene.
My child and I are aware that there are inherent risks in tumbling and the above listed activities (the “Activity”), including, but not limited to,
those of bodily injury, partial or total disability, paralysis, and death. We accept and assume such risks and the responsibility for the losses
and/or damages following such injury, disability, etc. and will not hold the Chavarria Institute of the Arts and all affiliated parties including,
but not limited to all instructors, staff, management, etc. in liability for such outcomes. 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 Chavarria Institute of the Arts 160 S. Old Springs Road #155 Anaheim, CA 92808, 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 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 CHAVARRIA INSTITUTE OF THE ARTS 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 CHAVARRIA
INSTITUTE OF THE ARTS FOR PERSONAL INJURY OR PROPERTY DAMAGE.
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.
WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19
ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of CHAVARRIA INSTITUTE OF THE ARTS programs and related events and
activities, the undersigned acknowledges, appreciates, and agrees that:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and
COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against
infectious diseases and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD
HARMLESS CHAVARRIA INSTITUTE OF THE ARTS their officers, officials, agents, and/or employees, other participants,
sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event
(“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS,
UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT.
FOR PARTICIPANTS OF MINOR AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this
waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the
rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks
and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees
and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities
incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR
NEGLIGENCE, to the fullest extent provided by law.
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