Medical Agreement

Feb 25, 2021 03:48 PM

DanzStar Studio
In consideration of the risk of injury while participating in dance (whether joining online classes or in-person) (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 DanzStar Studio, located at 945 PROVIDENCE SQUARE, SHOPPING CENTER, VIRGINIA BEACH, VA 23464.

❏ I am voluntarily participating in the aforementioned activity and have agreed to do so at my own risk. I am aware of the risk associated with traveling, 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 and physical activity. Nonetheless, I assume all related risks, both known and unknown to me, including travel to, from and during this activity. I acknowledge that DanzStar Studio 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 DanzStar Studio.

❏ 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.

❏ I agree to indemnify and hold harmless DanzStar Studio 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 DanzStar Studio incurs any of these types of expenses, I agree to reimburse.

❏ This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant and DanzStar Studio agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

❏ 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.

By signing electronically,
I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; I am at least eighteen (18) years old and fully competent to give my consent; I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

By checking the box below, you are consenting to use of your electronic initials in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead which we can have ready for you at your next studio visit. After consent, you may request a digital or paper copy of this waiver for your records. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. *