In Movement Dance Co.
Liability Waiver/Photo Release Form
I, ______________________________________, recognize and understand the risks of physical injury inherent to dance and dance training and I fully assume those risks. I hereby release In Movement Dance Co, event sponsors, employees, and dance teachers from all liability for injuries sustained or illnesses contracted while attending or participating in any dance classes, rehearsals, workshops, or performances. I agree to indemnify, defend, and hold harmless In Movement Dance Co, employees, and dance teachers for liabilities, costs, and judgments arising from acts of omissions committed by me or my child which result in injury or damage to any person or property. Initials:_______________
Protection of Property: I understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in any classes, rehearsals, workshops, or performances. I hereby release In Movement Dance Co., its affiliate dance studios, event sponsors, employees, and dance teachers from all liability for loss or damage to my personal property while attending or participating in classes, rehearsals, workshops, or performances. I also agree to abide by any rules, regulations and policies set forth by In Movement Dance Co. Initials: ________________
Medical Attention: In case of physical injury or medical emergency, I hereby authorize In Movement Dance Co. to make necessary arrangements to transport myself or my child to a medical treatment facility as necessary. All such transportation and medical treatment will be at my sole cost and expense. In extreme emergency, or if my child is under 18 years of age, I understand that In Movement Dance Co. will attempt to notify the person(s) listed as my emergency contact(s) of my condition and how to reach me. Initials: ________________
Photo Release: In Movement Dance Co. and all its employees/contractors reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting In Movement Dance Co. and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify In Movement Dance Co. prior to participation in class. Initials: ________________
Acknowledgement of Waiver: In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and am fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my or my child’s participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me or my child.
Print Name: _________________________________ Date: ____________________________