Participation Authorization


Dec 21, 2024 11:38 PM


As the parent or guardian of the registered child, I hereby give consent for the child(ren) to fully participate in all programs, events, and activities offered by Momentum Dance, LLC. I understand the nature of the program, events and activities and the child(ren)’s experience and capabilities and believe they are qualified to participate.

I understand and acknowledge that participation in such programs could result in injury to program participants and/or their exposure to illness and/or communicable diseases. I fully accept and assume all risk and responsibility as a result of the child(ren)s participation. I hereby release, waive, discharge and covenant not to sue Momentum Dance, LLC, its owners, officers, instructors, employees, contractors and agents (“Releasees”) from any and all liability, claims, demands or causes of actions whatsoever, including but not limited to claims for personal injury, harm, death, loss, damage and/or damage to personal property that may occur while participating in Momentum Dance, LLC programs and/or while on any premises where Momentum Dance, LLC is running activities, classes and/or camps whether or not owned, rented or managed by Momentum Dance, LLC.

I further agree that if, despite this release I, the child(ren) or anyone on behalf of the child(ren) makes a claim against any or all of the Releases, I will indemnify and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage or cost any Releasee may incur as the result of any such claim.

In the event of an accident or emergency, I hereby consent to Momentum Dance, LLC obtaining medical care from any licensed physician, hospital or clinic, including transportation and emergency medical services, for the child(ren)

I understand that Momentum Dance, LLC has rules and policies set in place to provide a safe and kid-friendly atmosphere. In registering for, and participating in, the programs and services provided by Momentum Dance, LLC, I understand that the child(ren) and I must adhere to and follow any rules and policies as well as terms and conditions set forth by Momentum Dance, LLC. At the discretion of the owners, management and/or staff, Momentum Dance, LLC reserves the right to deny service to anyone.

I understand that the information provided on this form and/or in the online registration process will be maintained in an online account for our access to future Momentum Dance programs and events. Personal information will be shared with third parties only in accordance with the policies as listed at www.momentumdancema.com.

I understand that Momentum Dance may inform me about future programs, events and specials via email, phone, etc. and that I will then have the opportunity to opt-out of each method of communication, if I so choose.

Studio Video Surveillance Notification.

For the safety of the studio, our personnel, and our students, certain portions of our premises may be monitored by video surveillance systems. Private areas, including restrooms and private changing areas, will never be under surveillance or recorded. In general, only studio personnel will have access to such recordings, however, where appropriate, we may need to provide these recordings to third parties aiding in an investigation, including, for example, law enforcement.

Policies, rules and terms of service are available online at www.momentumdancema.com and are subject to change with or without notice.