STATEMENT OF INFORMED CONSENT & RELEASE OF CLAIMS
I am the parent or guardian of the dancer being registered in this form/document, or am the adult dancer registering myself, if applicable, who is enrolling in a program of dance and/or workout instruction at Dance Alliance, L.L.C. I acknowledge that I am fully aware of the hazards and physical stresses associated with dance/any physical activity and I am not aware of any medical or mental condition which would prohibit myself or my minor child from safely participating in this activity. I will inform my instructor or Dance Alliance, L.L.C. of any physical or mental condition which I or my child may incur during the period of enrollment in the course activity which may interfere with his, her or my participation in the course activity.
In further recognition of the risks of injury and illness inherent in any dance/physical activity program, I hereby waive and release Dance Alliance, L.L.C., its owners, employees and agents, on behalf of my child and myself, from and against any and all claims, costs, liabilities, expense or judgements arising out of my participation or my child’s participation in Dance Alliance’s programs for any illness or injury resulting therefrom, and hereby agree to indemnify and hold harmless Dance Alliance, L.L.C., its owners, employees and agents from and against any and all claims, except for illness or injury directly resulting from gross negligence or willful misconduct on the part of Dance Alliance, L.L.C., its owners, employees or agents.
I also give permission to Dance Alliance, L.L.C. to use any dance photographs and/or videos taken of my dancer(s). These photos and/or videos may be used now or in the future for publicity purposes or for programs, posters, tickets, postcards and/or website designs along with social media. As well as the above, by my electronic signature, I acknowledge that I have read, understand, and agree to the Dance Alliance Policies and/or Procedures as defined in the registration packet that I received.
SIGNATURE BELOW (FULL LEGAL NAME)