ACTIVITY RISK WAIVER FORM FOR N&B DANCE FACTORY AND GYM

This activity risk waiver (this ‘Waiver”) date: _____________________________ (include year)

Between:

N&B Student/family/Natalie Porter and Persons in the studio or on equipment of _____________________.
(collectiviely the “Participant”)

Of the first part AND

N&B Dance Factory and Gym LLC of 62 E Main Salina Utah,
Natalie Porter of N&B and N&B Staff

Of the second part

In consideration of the covenants and agreements contained in the Waiver and other good an valuable consideration the receipt of which is hereby acknowledged, the paties to this Waiver agree as follows:

Consideration
Being of lawful age or representing a minor and in consideration of being permitted to participate in the activity described below, the Partipant and guardian releases and forever discharges the Activity Provider, the Activity Providers, spouse, heirs, executors, administrators, legal representatives and assigns from all manor of actions, causes of action, debts, accounts, bonds contracts, claims and demands for or by reason of any injury to person or property, includingi injury resulting in dealth of the Participant which has been or may be sustained as a consequence of the Participant’s participation in the activity described below, and not withstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Activity Provider.

The Participant understands that the Participant would not be permitted to participate in the activity described below unless the Participant signed this waiver.

Details of Activity
The Participant acknowledges that htis Waiver is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant, and with the intention of binding the participant’s spouse, heirs, executors, administrators, legal representatives and assigns.
Initials: ___________________
Fitness to Participate
5. The Participant acknowledges that the Participant does not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent the Participant form participating
in the above mentioned activity. If required, the Participant will obtain a medical examination and clearance.

Full and Final Settlement
6. The Participant hereby acknowledges and agrees that the Participant has carefully read this Waiver, that the Participant fully understands the same, and that the Participant is freely and voluntarily executing the same.

7.The Participant understands that by signing this Waiver, the Participant agrees to be forever prevented from suing or otherwise claiming against the Acitiviy Provider for any property loss or personal injury that the Participant may sustain while participating in or preparing for the above noted activity.

8.The Partaicipant has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this waiver.

9. This Waiver contains the entire agreement between the parties to this Waiver and the terms of this Waiver are contractual and not a mere recital.

Governing Law
10. This Waiver will be construed in accordance with the governed by the laws of the State of Utah.

11. The Participant’s emergency contact information is;

Name: _____________________________________________________

Phone Number: ______________________________________________

IN WITNESS WHEREOF the Participant and Activity Provider have duty affixed their signatures under hand and seal on the ____________ day of __________________, 20_________.

Per Witness: _____________________________________________________________
(N&B staff or other witness)

Participant Guardian Signature: ________________________________________________

Participant Signature: ________________________________________________________

Initials _____________