Chosen Kids Program Class/ Session Liability Waiver

Chosen Kids LLC- Liability Waiver

Parents/ Guardians: Please complete this waiver before your child participates in Zumba kids dance fitness led by Zumba B1 and Zumba kids, and Zumba kid jr., licensed instructor, Tanya E. Douglas of Chosen Kids LLC. Please forward any questions to chosenkidsprogram@gmail.com or call/ text (215) 804-9166.
Parent or Guardian's First Name*
Please enter full first name of parent or guardian.
Parent or Guardian's Last Name*
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Parent or Guardian's Email*
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Street Address

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Are you 18 years or older?*

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Child's Full First and Last Name

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What is your child's age range?

4-78-1112-1415-17
Please enter your child's birthday. This information will be used for birthday rewards.*

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Child's Full First and Last Name

First NameLast Name
What is your child's age range?

4-78-1112-1415-17
Please enter your child's birthday. This information will be used for birthday rewards.

MonthDayYear

Chosen Kids LLC- Class Liability Waiver

I, the undersigned, as the parent or legal guardian of the child/children named above, do hereby give my full consent and approval for my child/children to participate in the Zumba kids or Zumba kids jr. dance fitness classes.

I understand that all Zumba, Zumba kids, Zumba kids jr. classes and sessions requires physical exertion that may be strenous and may cause physical injury, including death, and I am fully aware of the risk of injury, even serious or disabling and hazards involved is always present and cannot be entirely elminated.

I agree to assume all of these risks on behalf of my child/children. I assume full responsibility for any and all damages, which may incur through participation. Participating in Zumba, Zumba kids or Zumba kids jr. is not recommended, and, is not safe under certain medical conditions.

Further, I agree that in consideration for the right to allow my child/children to participate in the Activity:

1.    On behalf of my child/children and myself, I do voluntarily elect to accept and solely assume all risks of damage, theft and/or injury incurred or suffered by my child/children: (a) while participating in the Activity; (b) while observing others participate in the Activity; and (c) while on or upon the premises of any and all of the locations arranged for performance of the Activity.

2.    In addition to giving my full consent for my child’s/children’s participation, I do hereby waive, release, discharge and agree not to sue Tanya Douglas of Chosen Kids LLC, its affiliates, directors, officers, employees, volunteers, agents, and contractors (“Releasees) for any claim, damages, costs including attorney fees, or cause of action which I or my child/children have or may have in the future as a result of damages, injuries, including death, sustained or incurred by my child/children from whatever cause including, but not limited to, my child’s/children’s conduct and/or the negligence or wrongful conduct of the parties of the Releasees.

3.    I agree on behalf of myself and my child listed below, that I shall hold harmless and fully indemnify the Releasees from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me or by, through or on behalf of my child, even if the damages, injuries or death are caused in whole or in part by any of the Releasees.

4.    I agree that if any portion of this Form is determined by a court of law to be invalid, that the remainder will continue in full force and effect. I further agree that the contents of this Form shall be construed to provide the broadest waiver, release, indemnification, and consent possible.

I acknowledge: (a) that I have read each and every one of the provisions in this Form; (b) that I understand each of the provisions in this Form; and (c) that I agree to abide by them.

I voluntarily agree to the terms and conditions stated above. This agreement stays into effect for as long as I (or any child listed as a minor in this waiver) participate in any Zumba (Zumba Kids, Zumba Kids Jr.) dance fitness classes or workshops.
AGREE (Liability Waiver)*

YesNo

Photo/Video Release I hereby grant The Chosen Kids Program and Tanya E. Douglas permission to use my likeness in a photograph, video, or other digital media (“photo”) in web- based publications and online social media (e.g. Instagram, Facebook, Twitter, Snapchat, Google search) without payment or other consideration. I hereby irrevocably authorize Tanya E. Douglas to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge Tanya E. Douglas from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO/VIDEO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES.
AGREE (Photo/Video Release)*

YesNo
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Date*

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Chosen Kids LLC- Liability Waiver