Assumption of Risk, Release of Liability for Personal Injury, Medical Authorization
In consideration for my child being permitted to participate in the programs and use the equipment, apparatus, facilities
and services of Visionary Dance Company, I do hereby agree to the following:
1.By signing this release, hold harmless and indemnification, I acknowledge my understanding and acceptance of
the following:
A. That Dance/Pilates is an active sport, which requires strength, agility and concentration and that it is solely my responsibility to determine that my child is in good health and good physical and mental condition before permitting my child to exercise, work out, receive instruction or perform.
B. That dancing requires twisting, turning, tumbling, jumping, flexion, extension and rotation, which movements are often performed with considerable force which can result in severe, permanent personal injuries, including, but not limited to, bruised, strained, sprained or torn muscles, tendons and ligaments, broken bones, derangements or dislocations of joints, and concussion.
C. That dance requires the use of apparatus and equipment, which may cause or contribute to severe, permanent personal injuries, such as those described above.
2. I hereby release Visionary Dance Company, its owners, operators, instructors, employees, agents, servants and affiliates from any and all liability or in any way related to my or my child’s use of the facilities, equipment, or apparatus of Visionary Dance Company; and/or my or my child’s participation in any class, program, competition or other event organized, run and/or sponsored by or held by Visionary Dance Company.
3. I hereby agree to indemnify, save, and hold harmless, Visionary Dance Company, its owners, operators, instructors, employees, agents, servants and affiliates from any loss, liability, damage or cost they may incur due to the participation in any program or use of any equipment affiliated with the Visionary Dance Company whether caused by its negligence or otherwise.
4. I hereby assume full responsibility for the risk of bodily injury, death, or property damage to myself or to my child due to negligence of Visionary Dance Company its owners, operators, instructors, employees, agents, servants and affiliates, or otherwise while using the premises or any facilities or equipment thereon or participating in any program affiliated with Visionary Dance Company.
5. In the event of an accident or emergency I would like my above mentioned child to be taken to a hospital for medical treatment and I hold Visionary Dance Company and its representatives harmless in their execution of this action. I further agree that I shall be solely responsible for all possible future medical or other expenses which may be incurred as a result of any injury sustained by my child while participating with, at or for Visionary Dance Company.
6. I authorize Visionary Dance Company to use photographs, videos, or other images of my child for promotional purposes in any type of media, including its website. I understand that I will not be paid or rewarded for providing this authorization.
7. I further expressly agree that the foregoing release, hold harmless and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Wisconsin and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
8. I have read and voluntarily sign this release, hold harmless and indemnification agreement, have been given the opportunity to speak with a representative of Visionary Dance Studio before signing this release, and further agree that no oral representations, statements or inducement apart from the foregoing written agreement have been made.
