SOUTHWEST FLORIDA DANCE ACADEMY, LLC
WAIVER OF LIABILITY RELEASE ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
Participant Full Name: _________________________________________________________________ Parent Full Name (if under 18 years of age): ________________________________________________ Address of Participant: _________________________________________________________________
D.O.B.: ______________
THE UNDERSIGNED hereby acknowledges his or her understanding that there are inherent physical risks associated with dance, cheerleading, yoga and exercise related activities of any kind. The undersigned knowingly and voluntarily accepts all associated risks and declare myself or my child to be physically sound and not suffering from any condition, impairment, disease, infirmity, illness or physical limitation that would prevent my or my child’s participation in dance, cheerleading or other exercise related activities, classes, workshops or performances offered by SOUTHWEST FLORIDA DANCE ACADEMY, LLC, a Florida limited liability company. I understand and declare that SOUTHWEST FLORIDA DANCE ACADEMY, LLC has taken and will take every precaution to minimize such risk of injury or illness to maximize the safety of all participants, however some inherent risks understandably remain which cannot be controlled by SOUTHWEST FLORIDA DANCE ACADEMY, LLC or its owners, employees or agents.
IN CONSIDERATION OF THE ABOVE, the undersigned hereby assumes all risk and agrees as follows:
I expressly assume all risks and take full responsibility for any injuries, damages, or losses which I or my child may incur or sustain as a result of participation in any activities offered by SOUTHWEST FLORIDA DANCE ACADEMY, LLC, and I, the undersigned, for myself (or on behalf of my child), my heirs, my administrators, and my executors, do hereby fully forever release and discharge SOUTHWEST FLORIDA DANCE ACADEMY, LLC, and its owners, employees or agents from any and all claims, demands, damages, rights or actions or causes of action (present or future), whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my or my child’s participation in classes, workshops, or other activities offered by SOUTHWEST FLORIDA DANCE ACADEMY, LLC. I, the undersigned, do hereby authorize SOUTHWEST FLORIDA DANCE ACADEMY, LLC or its designated employees or agents to obtain medical treatment for myself or my child in an emergency situation if needed or necessary. I understand that I am responsible for any medical expense and the absence of my own health insurance does not make SOUTHWEST FLORIDA DANCE ACADEMY, LLC responsible in any way for payment of my or my child’s medical expenses. SOUTHWEST FLORIDA DANCE ACADEMY, LLC will make no evaluation or recommendation whether participants, students or guest are sufficiently fit for any exercise or dance related activities. It is always advisable to consult your or your child’s physician before undertaking a dance or physical exercise program
I hereby release, waive, discharge and covenant not to sue SOUTHWEST FLORIDA DANCE ACADEMY, LLC, and its owners, officers, agents and employees, concerning any and all liability they may be determined to have, whether caused by their negligence or otherwise, concerning any injuries or damages I or my child may suffer or sustain from the decision to participate in dance, cheerleading, yoga or exercise related activities provided by SOUTHWEST FLORIDA DANCE ACADEMY, LLC, including, but not limited to, physical or mental injuries, death, financial loss, medical expenses and property damages. This release and waiver shall apply to my (or my child’s) heirs, personal representatives, next of kin, assignees and any other person or entity acting on my behalf or acting through subrogation. I am relying upon my own judgment in assuming all risk of injury and damages and agree to indemnify and hold harmless SOUTHWEST FLORIDA DANCE ACADEMY, LLC and its owners, officers, agents and employees, from all loss incurred, including expenses incurred in any attempt to hold them responsible for any injuries or damages I may suffer or sustain by participating in dance, cheerleading, yoga or exercise related activities. I FURTHER EXPRESSLY AGREE that the forgoing Release, Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted under Florida law, and if any portion of this Agreement is held invalid, the balance shall continue in full force and legal effect.
PARENT / GUARDIAN WAIVER FOR MINORS (Only if participant is under 18 years old):
The undersigned parent or guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal
guardian.
BY SIGNING BELOW, I, THE UNDERSIGNED, EXPRESSLY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND FULLY UNDERSTAND IT IS A RELEASE OF LIABILITY. NO OTHER REPRESENTATIONS, STATEMENTS OR INDUCEMENTS HAVE BEEN MADE TO ENCOURAGE MY OR MY CHILD’S PARTICIPATION AND I AGREE TO BE BOUND BY THE TERMS AND CONDITIONS STATED HEREIN.
________________________________________________________ Date: ________________________________ Participant Signature (if under 18, parent or legal guardian must sign)