Agreement of Release and Waiver of Liability
Sign in to Google to save your progress. Learn more
Full Name *
Email address *
Street Address *
City, State, Zip *
Phone number *
Assumption of Risks:
In consideration of being permitted to participate in any way in a class with Meleah Nelson hereinafter called "The Activity", I understand and agree that in participating in any dance class, fitness class, workshop, rehearsal, performance, training session or other physical activities, there is a possibility of physical injury. Participation in these activities carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions.

If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor.  I assume full responsibility for any and all damages, which may incur through participation.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in any dance class, fitness class, workshop, rehearsal, performance, training session or other physical activities, including, but not limited to, a class with Meleah Nelson. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

I affirm that a licensed physician has verified my good health and physical condition to participate in such a program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate.

I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in The Activity.

Waiver:
I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Meleah Nelson and any and all instructors, dancers, staff members, facilities, agents, volunteers, employees, guest artists, audience members and/or students, legal representatives, and/or successors, related to, working in or with and/or otherwise involved with a class with Meleah Nelson, and all persons or corporations acting with their permission, from liability from any and all claims or demands now and in the future, including the negligence of Meleah Nelson, and any and all instructors, dancers, staff members, facilities, agents, volunteers, employees, guest artists and/or students, related to, working in or with and/or otherwise involved with a class with Meleah Nelson, resulting in personal injury, accidents or illnesses, and property damage or loss arising from, but not limited to, participation in The Activity.

I voluntarily agree to assume the full risk of any and all injuries, damages, or loss, regardless of severity, that I and my family may sustain as a result of using the services of Meleah Nelson.

Indemnification and Hold Harmless:
I will not hold liable Meleah Nelson, and any and all instructors, dancers, staff members, facilities, agents, volunteers, employees, guest artists, audience members and/or students, legal representatives, and/or successors, related to, working in or with and/or otherwise involved with The Activity, and all persons or corporations acting with their permission, liable for any personal injury or any personal property damage or loss which may occur before, during or after classes, sessions, performances or activities related to The Activity on any premises or facilities involved or related to The Activity.

Acknowledgment of Understanding:
I have read this waiver of liability, assumption of risk, and indemnity agreement, participation agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law in the state of California.

I understand and agree that this Agreement will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I may have or have had, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my use of Meleah Nelson’s services. This Release constitutes a complete release, discharge and waiver of any and all actions or causes of action relating to The Activity.

I understand and agree that this Agreement applies to personal injury, or wrongful death which I and/or my family members may suffer.

I understand and agree that by signing this Agreement, I am assuming full responsibility for any and all risk of death or personal injury on me or my family members while utilizing The Activity.

I understand and agree that this Agreement will be binding on me, my family members, my personal representatives, my assigns, and any guardian for family members, in the event of my death or incapacity.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms

I agree that any dispute regarding this agreement will first be tendered by the parties to a member of The American Arbitration Association for resolution prior to the filing of any lawsuit. I also agree, failing a successful arbitration effort, any suit to be tendered will be filed in a under the laws of the State of California.

Agree to Release & Waiver of Liability *
Electronic Signature (write in name) *
This agreement is signed when a party’s signature is delivered by electronic medium. These signatures must be treated in all respects as having the same force and effect as original signatures.
Date Signed *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy