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WAIVER AND RELEASE OF LIABILITY
In consideration of the risk of injury while participating in Dance (the "Activity"), and as consideration for
the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or
personal representatives, knowingly and voluntarily enter into this waiver and release of liability and
hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my
participation in the Activity, and do hereby release and forever discharge Gleams, Inc. dba Creative
DanceN', located at 3371 Cleveland Road Suite 110 , South Bend, Indiana 46628, as well as their outreach program at O'Brien Center 321 E. Walter St, South Bend, Indiana 46614, part of the South Bend Parks and Recreation Department, their affiliates, managers,
members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns,
for any physical or psychological injury, including but not limited to illness, paralysis, death, damages,
economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned
Activity, including traveling to and from an event related to this Activity.
I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM
PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE
RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN
THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR
PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY
OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL
LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE
FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR
THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL
RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS
ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.
I agree to indemnify and hold harmless Gleams, Inc. dba Creative DanceN' against any and all claims, suits
or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or
anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any
claims made by me or by anyone else acting on my behalf. If Gleams, Inc. dba Creative DanceN' incurs any
of these types of expenses, I agree to reimburse Gleams, Inc. dba Creative DanceN'.
that Gleams, Inc. dba Creative DanceN' and their directors, officers, volunteers,
representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or
entity conducting a specific event or activity on behalf of Gleams, Inc. dba Creative DanceN'.
I ACKNOWLEDGE THAT THIS ACTIVITY MAY INVOLVE A TEST OF A PERSON'S
PHYSICAL AND MENTAL LIMITS AND MAY CARRY WITH IT THE POTENTIAL FOR
DEATH, SERIOUS INJURY, AND PROPERTY LOSS. The risks may include, but are not limited to,
those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants,
equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers,
spectators, coaches, event officials and event monitors, and/or producers of the event.
I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE"
AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE
DISCHARGE Gleams, Inc. dba Creative DanceN' AND ALL OF ITS
AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS,
HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY
AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR
WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST
Gleams, Inc. dba Creative DanceN' FOR PERSONAL INJURY OR PROPERTY DAMAGE.
To the extent that statute or case law does not prohibit releases for negligence, this release is also for
negligence on the part of Gleams, Inc. dba Creative DanceN', its agents, and employees.
In the event that I should require medical care or treatment, I agree to be financially responsible for any
costs incurred as a result of such treatment. I am aware and understand that I should carry my own health
In the event that any damage to equipment or facilities occurs as a result of my or my family's willful
actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated
with any actions of neglect or recklessness.
In the event that any provision contained within this Release of Liability shall be deemed to be severable or
invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or
otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as
the clause severed does not affect the intent of the parties. If a court should find that any provision of this
agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and
enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.
In the event of an emergency, please contact the following person(s) in the order presented:
I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing
this agreement. I certify that I have read this agreement, that I fully understand its content and that this
release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am
signing it of my own free will.
PARENT / GUARDIAN WAIVER FOR MINORS
In the event that the participant is under the age of consent (18 years of age), then this release must be
signed by a parent or guardian, as follows:
I hereby certify that I am the parent or guardian of the student named above, and
do hereby give my consent without reservation to the foregoing on behalf of this individual.
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