Assumed Injury and Release of Liability Waiver

Participants Name*

First NameLast Name

Parent/Guardian Name (if participant is a minor)

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

I agree to the following:*

I affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms of COVID-19, including, but not limited to, cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell WITHIN THE LAST 14 DAYS.I affirm that I, as well as all household members, do not have any pending COVID-19 test results.I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 14 DAYS.I understand that neither School of HipHop PHX nor any of its affiliates can be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each participant.

By signing below, I agree to each statement above and release School of HipHop and any and all participants in this event who can be proved to be truthful on this waiver from any and all liability for the unintentional exposure or harm due to COVID-19, nor will I intentionally harm any other participants myself.

Informed Consent and Acknowledgement

There is a risk of being injured that is inherent in all sports activities, including dance. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or even death.

In case of injury, I hereby waive all claims against School of HipHop and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct this event which includes, but is not limited to, Black Children and Families Services Agency and it's owners, partners, and members.

Furthermore, all images and videos of School of HipHop events are the property of School of HipHop and can be used for any promotional consideration. Although, we usually seek your personal permission for all largely used photo imagery.

I hereby state that I have carefully read the above waiver. Acceptance and understanding of this agreement are hereby acknowledged.

I have read and agree to the Informed Consent and Acknowledgement.

Date

By typing your name below, you agree that you have read, answered honestly, and agree to all above information. Failure to sign this waiver will result in disqualification from the use of School of HipHop*

Typed name is considered an electronic signature for the sake of this waiver