KDF Participation wavier
May 01, 2024 03:34 PM
Kingston Dance Force Studios Inc. Medical Information, Release Waiver & Assumption of Risk
RELEASE AND WAIVER OF LEGAL CLAIMS
READ AND REVIEW CAREFULLY
This Release and Liability Waiver (the “Waiver”) constitutes a legally binding agreement between:
Kingston Danceforce Studios Inc.
a business offering Dance training and instruction (“KDF”)
-and-
the person participating in a training class from KDF and, if applicable, their guardian (the “Client”)
1. I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and/or my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, successors, administrators, and executors, hereby waive, release, hold harmless and forever discharge Shannon Swain Reitzel and Chelsea Swain Deodato individually as well as Kingston Danceforce Studios, Inc. and its staff from any and all claims or damages of any kind including but not limited to personal injury, infectious disease, death, damage to property or loss of any kind that may arise out of participation in the exercise and/or dance programs of Kingston Danceforce Studios Inc. I do also hereby release Kingston Danceforce Studios Inc., Shannon Swain Reitzel, Chelsea Swain Deodato, and its officers, agents, employees, representatives, executors, and all others from any responsibility or liability for any injury or damage to the aforementioned student, including those caused by negligence , whether of KDF, Shannon Swain Reitzel, Chelsea Swain Deodato, or others. I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program.
I understand that by signing, I am giving up my legal rights to make a claim.
SIGNATURE of Participant: SIGNATURE of Guardian (if applicable):
2. I understand that dance includes strenuous physical movements and that the risk of serious or debilitating injury is always present and cannot be entirely eliminated. I understand that despite KDF taking reasonable steps to create a safe environment there always remains a risk of injury, including but in no way limited to: exhaustion; dehydration; bruising; fainting;
unconsciousness; and muscle, joint, ligament, and bone strains, breaks and sprains. I am fully aware of and willing to assume these risks and hazards involved.
3. I assume full responsibility for any and all damage, loss, or injury which may occur through participation in the activities of this class. If I/ the participant experience any pain or discomfort I/they will ask for support or assistance from the instructor. I understand that I/ the participant may rest at any point during the class and that it is my/the participant’s responsibility to do so should the need arise.
4. I affirm that a licensed physician has verified my/the participant’s good health and physical condition and has approved participation in such a fitness program, or that I have freely chosen not to seek the opinion of a physician. I understand it is my responsibility to discuss with my doctor any conditions that may affect safe participation in dance activities, such as existing injuries, current medical prescriptions, and overall physical conditioning. I affirm that I am unaware of any existing condition which would prevent safe participation in dance activities.
5.. I affirm that I have disclosed to KDF any and all pre-existing conditions or medical concerns. I understand that it is my sole responsibility to ensure that this medical information is accurate and up-to-date, and to advise KDF of any and all changes.
6. I am aware and accept that I am solely responsible for deciding whether to practice dance, and that I agree to participate at my own risk.
7. I acknowledge and confirm that no warranties or representations have been made to me regarding expected results from participation in the program or activities. I understand that individual results may vary.
8. I hereby release, waive and discharge KDF, Shannon Swain Reitzel and Chelsea Swain Deodato directors, officers, employees, coaches, teachers, instructors, volunteers, staff, representatives, and agents for any and all injury or loss that may arise during my participation in any dance activity at KDF, and from any cause whatsoever, including any negligence or breach of duty of care on the part of KDF, its owners or employees, or any other person or corporation. I understand that by signing, I am giving up my legal rights to make a claim.
9. I acknowledge that I hereby waive any and all right to legal claims against KDF, Shannon Swian Reitzel or Chelsea Swain Deodato, existing or future, and arising for any reason, including but not limited to negligence on the part of KDF, its directors, officers, employees or otherwise. In doing so, I am giving up my right to make or pursue any existing or future legal claims, including in the event of loss, damage, or injury. I understand that by signing, I am giving up my legal rights to make a claim. SIGNATURE of Participant:
SIGNATURE of Guardian (if applicable):
10. Where this waiver is signed on behalf of a minor, the signing Guardian agrees to hold harmless and indemnify KFD, Shannon Swain Reitzel and Chelsea Swain Deodato for any and all claims, settlements or legal awards resulting from injury brought by or on behalf of the minor on whose behalf I have signed.
I understand that by signing, I may be liable to KDF or to third parties.
SIGNATURE of Guardian:
11. I was given the opportunity to obtain legal advice before signing this waiver, and have either done so or chosen not to do so on my own accord. I understand that this is a legally binding document.
12. I was provided ample opportunity to review this document prior to beginning any dance activities, have had the opportunity to ask any questions, and have received satisfactory answers.
13. I voluntarily consent to be bound by the present waiver, free of any inducement or undue influence.
I have read and understand all of the above terms:
to participate in dance activities. KDF, its agents, employees, and instructors, may collect further information, including information relating to a participant’s performance, progress, and participation in activities offered by or in connection with KDF. This information may be shared internally within KDF, with parents or guardians of the participant, with other organizations as needed for registration or participation purposes. Information will also be shared as required by law, and with any person or organization for the purposes of obtaining health care. Participants or their parents or guardians may access or correct the information held by KDF by contacting
I consent to the collection of this information: 2) For Parents & Guardians:
I, the undersigned, do hereby authorize Shannon Swain Reitzel and/or Chelsea Swain Deodato or their designated agents (being teachers or administrators employed by Kingston Danceforce Studios Inc.) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. Additionally, I understand that I am responsible for any medical expenses that may be incurred. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician.
I have read and understand all of the above items:
PLEASE READ AND REVIEW CAREFULLY
This Release and Liability Waiver (the “Waiver”) constitutes a legally binding agreement between:
Kingston Danceforce Studios Inc.
a business offering Dance training and instruction (“KDF”)
the person participating in a training class from KDF and, if applicable, their guardian (the “Client”)
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and prohibitions with which Kingston Danceforce Studios Inc., (“KDF") will comply.
All references to COVID-19 in this document shall include the viral pathogen which causes COVID-19 as well as the disease itself, whether symptomatic or asymptomatic.
1. I understand that risk of contracting COVID-19 or other infectious illnesses is inherent in participating in activities offered by or in conjunction with KDF, and I, on behalf of myself and/or my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, successors, administrators, and executors, hereby waive, release, hold harmless and forever discharge Shannon Swain Reitzel and Chelsea Swain Deodato individually as well as Kingston Danceforce Studios, Inc. and its staff from any and all claims or damages of any kind including any and all claims relating to COVID-19, whether for personal injury, infectious disease, death, damage to property or loss of any kind that may arise out of participation in the exercise and/or dance programs of Kingston Danceforce Studios Inc. I do also hereby release Kingston Danceforce Studios Inc., Shannon Swain Reitzel, Chelsea Swain Deodato, and its officers, agents, employees, representatives, executors, and all others from any responsibility or liability for any injury or damage to the aforementioned student, including those caused by negligence , whether of KDF, Shannon Swain Reitzel, Chelsea Swain Deodato, or others. I further confirm that the aforementioned student is in proper physical condition to participate in the exercise/dance program. I understand that by signing, I am giving up my legal rights to make a claim.
SIGNATURE of Participant:
SIGNATURE of Guardian (if applicable):
2. I understand that it is my responsibility to fully and accurately complete any and all COVID-19 or other health screenings, and that failure to do so may result in consequences including expulsion, without refund, from activities offered by KDF.
3. I assume full responsibility for any and all damage, loss, injury or otherwise which may occur through participation in activities offered by, through, or in relation to KDF, including contracting COVID-19 or any other illness.
4. I further understand and acknowledge that KDF is not responsible for any failure by any other participants to adhere to COVID-19 regulations or failure to honestly respond to COVID - 19 screening. I hereby waive any legal claim, existing or future, against KDF, Shannon Swain Reitzel and Chelsea Swain Deodato and any and all directors, officers, employees, coaches, teachers, instructors, volunteers, staff, representatives, and agents resulting from the failure of any person to adhere to COVID-19 screening and other measures, including, but not limited to, failure to social distance and failure to accurately and truthfully answer screening questions. I understand that by signing, I am giving up my legal rights to make a claim.
5. I affirm that I have accurately and truthfully answered KDF’s health screening questions and will continue to do so whenever required, and acknowledge that KDF may, at its sole discretion, require me to complete a health screening at any time.
6. I am aware and accept that I am solely responsible for deciding whether to practice dance, and that I agree to participate at my own risk, including risk of COVID-19. I agree that I will not participate in any activities if I or a close contact have symptoms of COVID-19, have been diagnosed with COVID-19, have been advised or instructed to self-isolate.
7. I acknowledge and confirm that KDF makes no warranties or representations with respect to measures to contain and control infectious disease, including COVID-19.
8. I hereby release, waive and discharge KDF, Shannon Swain Reitzel and Chelsea Swain Deodato and any and all directors, officers, employees, coaches, teachers, instructors, volunteers, staff, representatives, and agents for any and all injury or loss that may occur to me or others as a result of my participation in any dance activity at KDF, including as a result of contracting COVID-19 or any other infectious disease, and from any cause whatsoever, including any negligence or breach of duty of care on the part of KDF or of any person or corporation.
9. I acknowledge that I hereby waive any and all right to legal claims against KDF, Shannon Swain Reitzel or Chelsea Swain Deodato, existing or future, and arising for any reason, including but not limited to negligence on the part of KDF, its directors, officers, employees or otherwise. In doing so, I am giving up my right to make or pursue any existing or future legal claims, including in the event of loss, damage, or injury, whether from COVID-19 or any other cause.
SIGNATURE of Participant: SIGNATURE of Guardian (if applicable):
10. Where this waiver is signed on behalf of a minor, the signing Guardian agrees to hold harmless and indemnify KFD, Shannon Swain Reitzel and Chelsea Swain Deodato for any and all claims, settlements or legal awards resulting from injury brought by or on behalf of the minor on whose behalf I have signed. I understand that this may mean that I am legally liable to KDF or to third parties.
SIGNATURE of Guardian:
11. Should any third party contract COVID-19 or any other infectious disease as a result of my participation in any activity offered by or through KDF or as the result of my actions, including, but not limited to, my failure to adhere to COVID-19 measures or regulations, the undersigned agrees to hold harmless and indemnify KFD, Shannon Swain Reitzel and Chelsea Swain Deodato for any and all claims, settlements or legal awards resulting from injury brought by or on behalf of the minor on whose behalf I have signed. I understand that this may mean that I am legally liable to KDF or to third parties.
SIGNATURE :
11. I was given the opportunity to obtain legal advice before signing this waiver, and have either done so or chosen not to do so on my own accord. I understand that this is a legally binding document.
12. I was provided ample opportunity to review this document prior to beginning any dance activities, have had the opportunity to ask any questions, and have received satisfactory answers.
13. I have been sufficiently warned of the risk relating to COVID-19 and other illnesses resulting from participation in any activities offered by, through, or in conjunction with KDF, have had the opportunity to ask questions, and have received answers to my satisfaction.
14. I voluntarily consent to be bound by the present waiver, free of any inducement or undue influence.
I have read and understand all of the above items: