VISITOR WAIVER AND RELEASE FORM

LIABILITY FOR DANCE INSTRUCTION/ACTIVITIES (video/photography release included)

I, ______________________________________ (PRINT YOUR NAME) have chosen to have my child, ____________________________________ (PRINT CHILD’S NAME), participate in the dance instruction/activities given by Danceworx Academy. I acknowledge that I understand the nature of the activities my child will be participating in and that my child is in the proper physical condition and capable of participating in the related activities, understanding that Danceworx Academy is not in any way responsible for making such a determination.

In consideration of my child’s enrollment in any dance instruction program or Danceworx event, I understand and agree on behalf of myself and my child, to release, hold harmless, and discharge Danceworx Academy from all claims, costs, liabilities, expenses or judgments, including attorney’s fees and court costs for any occurrences in connection with any dance instruction. I assume all risks to my child in connection with any instruction and further release Danceworx Academy and its owners and employees from liability for any injury sustained by my child while s/he is enrolled in any dance instruction program, including all risks reasonably connected with such activity whether foreseen or unforeseen.

I understand that Danceworx Academy is not responsible for my child or other children under my supervision who are left unsupervised in the common areas and areas surrounding the dance studio and that Danceworx Academy will only be supervising my child when s/he is participating in scheduled dance activities, programs, and instruction.

I understand that Danceworx Academy is not responsible for personal property that is lost, damaged, or stolen while I or my child is at or on Danceworx Academy property.

I acknowledge and agree that it is my responsibility to maintain my own accident and health insurance coverage that provides adequate coverage for myself and my child participating in Danceworx Academy activities and that Danceworx Academy does not provide accident or health insurance for those participating in its instruction, activities or programs.

I authorize and agree that Danceworx Academy may take and use photographs, videos or likenesses of myself and my child as needed for its record-keeping, advertising, and/or public relations projects and that I have no rights to the same and will not be compensated for the same.

My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuit to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.

I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO SIGNING.

Parent Signature ______________________________________________ Date _____________

Print Parent Name_______________________________________________________________