BELLETETE BALLET STUDIO, LLC
WAIVER AND RELEASE FROM LIABILITY FOR DANCE INSTRUCTION
Belletete Ballet Studio, LLC takes the safety of its dancers very seriously. However, with any physical activity there are possible risks involved. In order to deal with any type of emergency, we require all parents or guardians to sign this consent and emergency release form.
I, ______________________________________ (PRINT YOUR NAME) have chosen to have my child,
________________________________ (PRINT CHILD’S NAME), participate in dance and acrobatics instruction given by Belletete Ballet Studio, LLC (aka Belletete Ballet). I acknowledge that I understand the nature of the activities myself and/or my child will be participating in and that I and/or my child is in the proper physical condition and capable of participating in the related activities, understanding that Belletete Ballet is not in any way responsible for making such a determination.
In consideration of my child’s enrollment in any dance or acrobatics instruction program, I understand that participating in any dance classes and acrobatic dance/tumbling (acro-dance) involves inherent risks and hazards. I freely accept and fully assume all such risks, dangers, and hazards and the possibility of personal injury, property damage, or loss resulting from such risks and hazards. I agree on behalf of myself and my child, to release, hold harmless, and discharge Belletete Ballet Studio, its Director Meghan Houlahan and all instructors, contractors, representatives and agents from all liability for any loss, damage, injury, expense, claims, costs, liabilities, expenses or judgments, including attorneys’ fees and court costs for any occurrences that I or my next of kin, successors or dependents may suffer or incur as a result of participation in classes, demonstrations and performances due to any cause whatsoever in connection with any dance or acrobatics instruction. I assume all risks to my child in connection with any instruction and further release Belletete Ballet Studio and its owners, directors and employees from liability for any injury sustained by myself and/or my child while he or she is enrolled in any dance instruction program, including all risks reasonably connected with such activity whether foreseen or unforeseen.
I fully understand that Belletete Ballet staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release Belletete Ballet staff to render first aid to my child or children in the event of an injury or illness, and if deemed necessary by Belletete Ballet staff to call 911 to seek emergency medical assistance.
I understand that dance instruction may require an instructor to physically manipulate a dance student’s posture during class time for the purposes of correcting dance technique, and I or my parent/guardian agree to allow this physical correction and hold harmless and release Belletete Ballet from any liability regarding such.
I understand that Belletete Ballet is not responsible for my child or other children under my supervision who are left unsupervised in the common areas and areas surrounding the dance studio and that Belletete Ballet will only be supervising my child when he or she is participating in scheduled dance activities, programs or instruction.
I understand that Belletete Ballet is not responsible for personal property that is lost, damaged or stolen while I or my child is at or on Belletete Ballet’s property. I acknowledge and agree that it is my responsibility to maintain my own accident and health insurance coverage that provides adequate coverage for myself and my child participating in Belletete Ballet’s activities and that Belletete Ballet does not provide accident or health insurance for those participating in its instruction, activities or programs.
I authorize and agree that Belletete Ballet may take and use photographs, videos or likenesses of myself or my child as needed for its record-keeping, advertising and/or public relations projects and that I have no rights to the same and will not be compensated for the same.
My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.
I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO SIGNING.
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Signature of Participant’s Parent or Guardian Date
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Printed Name of Participant’s Parent or Guardian