Photo Release and Liability Form

Please complete this form one time per year. Names of all dancers may be entered on this form.

PARENT/GUARDIAN NAME*

PARTICIPANT NAME(S)*

Photo Release

I give Goins Dancing permission to use mine and/or my child's picture in or any form of advertisement for Goins Dancing or any Goins Dancing-affiliated event.*

YesNo

Goins Dancing Liability Waiver

Please read and check off that you understand each of the following .*

I understand that there are risks of physical injury/illness associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including all claims of negligence arising as a result of such activity from which liability could accrue to Goins Dancing, it’s officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to as “Goins Dancing”).I also understand that participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.I hereby agree to release Goins Dancing and hold Goins Dancing harmless of all liability.I hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury/illness arising out of active participation in dance as well as within the studio while not participating in dance on behalf of the participant and myself.I am aware this is a release of liability and acknowledge of my voluntary and knowing assumption of the risks of injury/illness. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.

Pertaining to Minors

I am a parent and/or legal guardian of 1 or more minor children who will participate in dance activities/events with Goins Dancing.*

YesNo

The minor participant(s) has my permission to participate in Goins Dancing activities/events. I warrant the below information is complete and correct. I further release Goins Dancing of all liabilities associated with my child's attendance at Goins Dancing. 2*

Yes

Participant or Parent/Guardian signature*

Photo Release and Liability Waiver