Inland Empire Dance Center & Inland Empire Contemporary Ballet

Indicated in the space below are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release Inland Empire Dance Center, Inland Empire Contemporary Ballet, Inc. the instructors, guest artists, Jamie Azpeitia-Sachs individually, staff and affiliates from any and all claims or damages of any kind arising out of my child’s participation in the exercise and/or dance program. I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do hereby authorize Jamie Azpeitia-Sachs or her designated agents (being teachers or administrators employed by (Inland Empire Dance Center and/or Inland Empire Contemporary Ballet, and affiliates) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make Inland Empire Dance Center and/or Inland Empire Contemporary Ballet and affiliates, responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect.

I release Inland Empire Dance Center, Inland Empire Contemporary Ballet, Inc. it’s instructors, independent contractors, and all other associates from liability for harm, theft, or injury that may be suffered by me and/or members of my family traveling to or from or during participation in activities and programs sponsored by Inland Empire Dance Center, Inland Empire Contemporary Ballet, Inc. I hereby acknowledge that I am voluntarily assuming full responsibility for all risks of physical injury arising out of active participation in a dance class or other dance related activities. I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntary assume the risk that I and/or my children may be exposed to or infected by COVID-19 by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families. I release Inland Empire Dance Center, Inland Empire Contemporary Ballet, Inc., its instructors, independent contractors and all associates from liability for harm, injury or death pertaining to COVID-19 and other contagious diseases and viruses. I understand that there are NO refunds for registration fees, costume, performance fees or classes. I understand that if my dancers class gets cancelled due to weather, sickness, or any issues arising from COVID-19 there is no refund for these missed classes. I understand and agree to Inland Empire Dance Center, Inland Empire Contemporary Ballet, Inc. policies and procedures. I understand that my(self) student must have this release form signed before attending class.
I agree to the mask mandate set by the Inland Empire Dance Center/Inland Empire Contemporary Ballet due to COVID-19 Pandemic; Regardless of vaccination status, all individuals are required to wear a mask safely over the nose and mouth when on the premises or at an event associated with the Inland Empire Dance Center/Inland Empire Contemporary Ballet. This includes students, parents, guests, instructors at all times. By signing, you are agreeing to this.