I hereby acknowledge that my participation in the dance classes and activities offered by Studio XIV Dance Company could involve possible personal injury. By signing this release form I assume all risks in connection with participating in the dance program. I agree to release and hold harmless the owner  of Studio XIV  Dance Company, each of their teachers, instructors, staff members, and facilities from any liability, cause of action, claims or demands now and in the future. I also hereby agree to not hold any of the Studio XIV Dance Company parties liable for any injury, damages, or losses in connection with my participation in the dance program.

I hereby authorize the Studio XIV Dance Company to utilize photographs, videos and recordings of myself, either captured by Studio XIV Dance Company or provided by me in any promotional material including but not limited to social media, websites and outlets, brochures, promotional videos, dance clips and posters. I hereby release and discharge the Studio XIV Dance Company parties of and form any and all claims, demands, causes of action, liability, damages, and losses of any kind and nature that arise directly or indirectly from the use of my name and or the images. The images are to be used exclusively by the Studio XIV Dance Company and may not be sold, licensed or otherwise transferred by the Studio XIV Dance Company.

I fully understand and acknowledge that the Studio XIV Dance Company parties are relying on the statements above and that my participation in the dance program are conditioned upon this Acknowledgement, Waiver and Release form