Liability Release and Assumption of Risk Form
I,___________________________ recognize that the Teacher is not responsible for any injuries that may occur in the classroom while the student is dancing or participating in any other activity. All precautions to safeguard the student are taken, including education of proper warm up and cool down techniques. The risk of sustaining injuries result from the nature of the activity and can occur without fault of either the student or dance studio, its employees/agents or the facility where the activity is taking place. By choosing to take part in this activity, you are accepting the risk that you/your child may be injured. The chance of an injury occurring can be reduced by carefully following instructions at all times while engaging in the activity. We have read the above and we understand that by participating in the activity we are assuming the risks associated with doing so. Initial: _________
By agreeing to this you are waiving important legal rights. Please read carefully. This agreement must be completed in full before you can participate in any activities La Crete Community Dance .
Release of Liability, Waiver of Claims, and Indemnity Agreement
I, on behalf of myself, my heirs, next of kin, executors, administrators, representatives and assigns, hereby forever waive all claims and release, discharge and hold harmless La Crete Community Dance and their representatives and agents including, without limitation, employees, participants, and all other entities associated or involved in the organization or staging of events or any other activities, including, but not limited to, volunteers, third party vendors, all venues in which activities or segments of activities are held, and the members, officers, directors, employees, representatives, assigns, affiliates, and agents of any of the above (collectively, the “Releases†); for any and all losses, costs, causes of action, claims or damages, including any claim for damages for personal injury to my person or personal property damage howsoever caused, arising out of or in connection with my taking part in dance, fitness or other related activities, notwithstanding that the same may have been contributed to or occasioned by, without limitation, the negligence, breach of contract or breach of any statutory or other duty of care of La Crete Community Dance, or any of the Releases. Initial: _________
Further, I authorize La Crete Community Dance to take all reasonable steps to respond to a medical or other emergency, including but not limited to the providing of immediate first aid and obtaining professional medical assistance, and I shall hold La Crete Community Dance and its representatives harmless and release La Crete Community Dance, its proprietors, employees, heirs, assigns and any other participants from any liability, cause of action, or damages howsoever caused from any misfortune, malady or tragedy, physical or otherwise, that may arise due to my participation in La Crete Community Dance classes. Initial: _________
Assumption of Risk
I acknowledge that I am aware of the possible risks, dangers and hazards associated with participating in dance, fitness and other related activities, including the possible risk of severe or fatal injury and property loss. I hereby assume these risks which include, but are not limited to: the possibility of physical injury to myself and others such as muscle strain, broken bones, concussion, soft tissue damage, infectious diseases, and cardiac arrest. Initial: _________
I certify that I have not been advised against participating in dance, fitness or other related activities by a qualified health professional. I acknowledge that La Crete Community Dance, permitting me to participate in dance, fitness and other related activities, accepts my statements on this release waiver.
Initial: _________
Assumption of Risk – Dance Classes
I recognize that dancing requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Dance Lessons. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Dance Lessons. Initial: _________
In consideration of being permitted to participate in the Dance Lessons, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which might incur as a result of participating in the program. In further consideration of being permitted to participate in the Dance Lessons, I knowingly, voluntarily and expressly waive any claim I may have against La Crete Community Dance and/or its agents for injury or damages that I may sustain as a result of participating in the program. I understand that recording of the Dance Lessons is strictly prohibited without permission. I agree to not reproduce, sell, share or distribute any recordings of the dance lessons. Initial: _________
I understand that music used in the videos is not property of La Crete Community Dance and is for educational purposes only. Signing up or participating in La Crete Community Dance Lessons does not grant me a license or permission to use third party copyright materials including music. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue La Crete Community Dance and/or its agents for any injury caused by their negligence or other acts. Initial: _________
Terms and Conditions of Classes
The participant has permission to partake in La Crete Community Dance classes. The participant is wearing appropriate clothing that is suitable for dance. The participant will participate in these dance classes at their own risk. You understand that, although rare, dance is a sport and injury may occur. La Crete Community Dance will not be held responsible for any injury that may occur during your dance class. Initial: _________
I AGREE TO THE ABOVE TERMS AND CONDITIONS:
Participant Name: _________________________________
______________________________________________
Participant Signature
For participants under 18 years of age, Parent/Guardian Signature is required.
Parent/Guardian Name: ____________________________________________
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Parent/Guardian Signature
Date: ____________________