I here by state that I will ready and sign the waiver upon my registration.
WAIVER OF LIABILITY
LUNA MIA DANCE STUDIO is a premier Dance Academy. Cultural Integration & Arts Association, popularly known as CINA, is in partnership with Luna Mia Dance Studio for programming and student management.
I choose to have my child/children participate in classes, performances, workshops, and other activities at Luna Mia Dance Studio of my own free will and certify that my child/children is/are in proper physical condition to take part in such activities.
If I have questions about whether an activity is suitable for my child/children to pursue, I will consult my health care provider in making that decision. If my child/children have any known physical vulnerabilities, conditions, or injuries, I agree to discuss them with the director before participating.
By signing this document, I release LUNA MIA DANCE STUDIO, registered in the state of New Jersey as LUNA MIA DANCE & ARTS, LLC, and Cultural Integration & Arts Association, popularly known as CINA, their directors, owners, students, teachers, staff, employees, volunteers, associates from any liability or claim that I or my representatives may have against Luna Mia and/or CINA with respect to any bodily injury, personal injury, illness, death, or property loss or damage that may result from my participation at Luna Mia Dance Studio.
I voluntarily release and forever discharge and hold harmless Luna Mia Dance Studio from any and all claims or demands for damages, loss of services, costs and expenses, injuries, attorney fees, and any other call for reparation from any and all injury to me or my property arising in any way from my participation in dance classes, camps, intensives, workshops, performances, troupes, the use of Luna Mia equipment or facilities, and any activities associated with Luna Mia Dance Stuio.
I understand that there are risks of physical injury associated with, arising out of, and inherent to dancing. These risks include the potential for slips and falls, sprains, strains, dislocations, soft tissue injuries, musculoskeletal injuries, pediatric conditions, and other risks not specified here.
Understanding these risks and the potential for others not listed, I agree to personally accept and assume all of the risks present in my participation at Luna Mia Dance Studio. My participation is entirely voluntary, and I choose to participate in spite of the risks.
Dance education sometimes requires hands-on instruction as well as verbal instruction. Instructors may correct dancers by touching their arms, legs, feet, hips, back and head to move them in the correct position. I acknowledge that this is a common standard in dance instruction and understand that it is my responsibility to communicate clearly with the teacher and/or the director if any form of touch is unacceptable for my child/children.
MEDICAL TREATMENT AND INSURANCE
I understand that Luna Mia Dance Studio does not assume any responsibility for or obligation to provide financial or other assistance in the event of injury or illness, including but not limited to medical, health, or disability insurance or support.
I release and discharge Luna Mia Dance Studio from any claim which may arise on account of any first aid, treatment, or service rendered in connection with my participation in Luna Mia activities or with the decision by any representative or agent of Luna Mia Dance Studio to consent to medical or dental treatment on my behalf in an emergency.
I understand that Luna Mia Dance Studio does not carry or maintain health, medical, dental, or disability insurance coverage for any participant. I agree to take responsibility for full payment of any emergency medical or dental costs related to my participation regardless of whether I have insurance coverage.
PHOTO AND VIDEO RELEASE
I understand that Luna Mia Dance Studio may take photo and video recordings of me and my Child/children's participation during classes and activities. I convey to Luna Mia Dance Studio full rights and interest in these recordings. I understand such recordings may be used in advertising or other published materials, physical or virtual.
If I do NOT consent to being photographed or video-recorded, I will make sure the director is aware of my concerns and the reasons for them.
By clicking on this waiver, I had read and understood the waiver and release forms listed above.
I hereby authorize Luna Mia Dance Studio to charge my credit or debit card every 1st of the month for my child/children's tuitions for dance classes.
Tuition payments are due on the 1st of every month. If your card payment is declined, you MUST contact Luna Mia Dance Studio and update your payment before the 10th of the month. There will be a $10 late fee if payment is not received before the 10th of the month.
I MUST notify Luna Mia Dance Studio If I do NOT want my child to continue classes at Luna Mia Dance Studio for any reasons. I WILL send an Email 30 days before the 1st on the following month to request any further payments debit for my bank account or credit/debit card.
If I do not return or do not bring my child/children back to classes without giving Luna Mia Dance Studio a written notice via email, or not cancel my subscription 30 days prior to the 1st of the following month, I'm aware that my tuition payment will continue until I cancel my subscription and no refunds will be made for the unattended months.
ACKNOWLEDGMENT AND DISCLOSURE
Students and parents are aware in making this agreement to participate in activities at Luna Mia Dance & Arts, LLC.
The parents attests that their child/children is/are in good physical condition and has no known or suspected medical conditions that would preclude vigorous physical activity.
As part of the consideration for participation, the student acknowledges and assumes all these risks and wishes to enroll in this course of instruction.
Luna Mia Directors had cleared out and sanitized the dance room area before and after classes.
I understand that during this COVID-19 Public Health Emergency I will NOT be permitted to enter the facility beyond the designated drop-off and pick-up area. I understand that this procedure change is for the safety of all persons present in the facility and to limit to the extent possible everyone’s risk of exposure. On the occasion that you must stay, seating will be limited and strict social distancing measures will be in place. Parents will have the ability to follow along with their child’s class remotely.
I understand that IF there is an emergency requiring me to enter the facility beyond the designated drop-off and pick-up area, I MUST sanitize my hands before entering, remove my shoes and wear a mask. While in the facility I must practice social distancing and remain 6ft from all other people, except for my own child.
I understand that to enter the studio premises my child must be free from COVID-19 symptoms. If, during the day, any of the following symptoms appear my child will be separated from the rest of the people in the studio. I will be contacted, and my child MUST be picked up from the studio within 15 minutes.
· fever of 100.4 degrees Fahrenheit or higher
· dry cough
· Shortness of Breath
· Loss of taste or smell
· Sore Throat
· Muscle aches
While many of these symptoms might be non-COVID-19 symptoms we are proceeding with by assuming they are Covid-19 during this Public Health Emergency. These symptoms typically appear 2-7 days after being infected so please take them seriously. You will need to be symptom free for 72 hours before returning to the facility.
I understand that my child must always wear a mask while in the studio and on studio premises.
I understand that students will be required to bring their own hand sanitizer and use it according to CDC recommended handwashing procedures every time they touch a surface in the studio.
Each student MUST remove their street shoes before entering the dance room and must change to their appropriate dance shoes.
I understand that outside of the dance studio, all students will comply with all state, county or local stay-at-home orders, and all contact with persons living outside our household will follow all state, county or local stay-at-home orders. My student and our family will comply with any and all state, county or local stay-at-home orders, will limit contact outside of the Academy to persons living in our household and will only go out to inside venues in which we can maintain a minimum 6 foot social distancing. I will follow any recommendations from the CDC that limits my risk for exposure including wearing a mask in all public areas and remaining 6ft from all other people.
I will immediately notify Luna Mia Dance Studio management if I become aware of any person with whom my child or I have had contact exhibits any of the symptoms listed in Number 1 above, is advised to self-isolate, quarantine, or has tested positive, or is presumed positive for COVID-19. Further, I will immediately notify Luna Mia Dance Studio management if anyone from my place of employment is presumed positive or tests positive for COVID-19 whether or not I have had direct contact with that person.
I understand that Students entering our studio will be in contact with children, families and employees who are also at risk of community exposure. I understand that no list of restrictions, guidelines or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection. I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herein.
I, certify that I have read, understand, and agree to comply with the provisions listed herein. I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by Luna Mia Dance Studio will result in disciplinary action up to and including termination of membership.
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