DANCE WITH MARC NUÑEZ

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Accident Waiver and Release of Liability Agreement

Emergency Contact

Email *

First Name *

Last Name *

ACCIDENT WAIVER AND RELEASE OF LIABILITY AGREEMENT

I hereby assume all of the risks of participating in any and all activities for which I have been engaged by MARC NUÑEZ, including (by way of example and not limitation) any risks that may arise from negligence or carelessness on the part of the entity being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in the activities for which I am being engaged, and have not been advised not to participate by a qualified medical professional. I further certify that there are no health-related reasons or problems which preclude my participation in this activity.

In consideration of my voluntary engagement and permitting me to participate in this activity, I hereby take the following action for myself, my executors, administrators, heirs, next-of-kin, successors and assigns as follows: FIRST, THAT I WAIVE, RELEASE AND DISCHARGE from any and all liability, including but not limited to liability arising from the negligence or fault of the entity or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, MARC NUÑEZ, and/or their directors, officers, employees, volunteers, representatives and agents, and the activity holders, sponsors and volunteers; and SECOND, THAT I INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons named in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during these activities.

This Accident Waiver and Release of Liability Agreement shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

Electronic Signature Consent for ACCIDENT WAIVER AND RELEASE OF LIABILITY AGREEMENT
*

By checking here, you are consenting to use of your electronic initials in lieu of an original signature on paper. After consent, you will receive a digital copy of this waiver for you 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.

Required

By adding my INITIALS here, I certify that I have read, understand and agree to the above-stated ACCIDENT WAIVER AND RELEASE OF LIABILITY AGREEMENT on the date of this form submission.
*

Emergency Contact Full Name *

Emergency Contact Phone Number *

Any relevant medications and/or medical conditions? (OPTIONAL)

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A copy of your responses will be emailed to the address you provided.

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