Clone of Pinewoods 2024 Registration Form

Customer (Parent) Details:

Parent Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

E-mail*

example@example.com

Dancer #1 Name*

First NameLast Name

Dancer #1 Date of Birth*

Date

Dancer Name #2

First NameLast Name

Dancer #2 Date of Birth

Date

My Products

Hip Hop Tots (2-3yrs.) Tuesday 10:15-11:00am Product Image

Hip Hop Tots (2-3yrs.) Tuesday 10:15-11:00am8 week Parent & Tot Dance Class

$100.00 Quantity

Total

$0.00

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that H4L LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that H4L LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families. I voluntarily seek services provided by H4L LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that:* I am not experiencing any symptoms of illness such as 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.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within the United States of America in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.I hereby release and agree to hold H4L LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from H4L LLC. I understand that this release discharges H4L LLC from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from H4L LLC. This liability waiver and release extends to all owners, partners, and employees.*

ATHLETIC WAIVER OF LIABLITY AND HOLD HARMLESS AGREEMENT. There are certain inherent risks associated with participating in sports and/or athletic training that cannot be eliminated. These risks include, but are certainly not limited to: (1) minor injuries such as scratches, cuts, bruises and strains; and (2) major injuries such as injuries to the eyes, infection, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis and even death. Also included in these risks are the same or similar injuries that might result from using training equipment, actual use of a field or training facilities, the acts of others or from the unavailability of emergency staff or emergency medical care (hereinafter we shall define all of these risks and potential injuries as “Risks”). All of these Risks will be present in the activities that you and/or your minor will be participating in at H4L LLC (the “Activities”). HAVING READ THIS PARAGRAPH and having an appreciation for and an UNDERSTANDING OF THESE RISKS, you hereby affirm that you and/or your minor’s participation in these Activities is voluntary and that you agree on behalf or yourself or your minor to all of the following: 1. ASSUMPTION OF RISK I, on behalf of myself and/or my minor, ASSUME ALL OF THE RISKS THAT MAY OR CAN ARISE OUT OF PARTICIPATING IN THE ACTIVITIES, INCLUDING BUT NOT LIMITED TO THE ATHLETIC ACTIVITY ITSELF, USE OF THE EQUIPMENT, FIELD OR FACILITIES, THE ACTS OF OTHERS OR THE UNAVAILABLITY OF EMERGENCY CARE, as well as those Risks described in the preceding paragraph. 2. INDEMNITY/HOLD HARMLESS I, on behalf of myself and/or my minor and/or our heirs, personal representatives and/or assigns, also agree to indemnify and hold H4L LLC, as well as their affiliates, parents, subsidiaries, assigns, partners, attorneys, members, employees, independent contractors, shareholders, officers, directors, and agents or any producers, investors, cast members or any other person or entity associated in any way with the ownership, operation or affiliation with recreational facilities and the creation, production or distribution of H4L LLC-related marketing content on any H4L LLC-owned website, harmless from any and all claims, causes of actions, lawsuits, arbitrations or proceedings as well as from any expenses, judgments, costs, fees, damages, expenses and/or liabilities, including attorneys’ fees incurred in defending or prosecuting any such claims brought against H4L LLC as the result of my or my minor’s participation in the Activities. I hereby allow H4L LLC to use my or my minor’s image or likeness without current or future compensation for marketing purposes related to H4L LLC. 3. RELEASE/WAIVER In consideration for being permitted to participate in the Activities, I, on behalf of myself and/or my minor and/or our heirs, personal representatives and assigns HEREBY RELEASE, WAIVE AND DISCHARGE H4L LLC from any and all liability associated with or related to my or my minor’s participation in the Activities and agree NOT TO SUE H4L LLC for any reason resulting from or associated with my or my minor’s participation in the Activities. This waiver and release is intended to include all claims for injuries, accidents, illnesses, or property loss, whether known or unknown or anticipated or unanticipated, which are in any way related to or associated with the Activities. 4. NO INSURANCE I, on behalf of myself and/or my minor, acknowledge that H4L LLC does not carry insurance on behalf of myself or my minor.5. LEGAL RIGHTS I, on behalf or myself and/or my minor, understand and acknowledge that I/we are surrendering valuable legal rights in this agreement. 6. SEVERABILITY I, on behalf or myself and/or my minor, understand and expressly agree that this agreement is intended to be as broad and inclusive as permitted by the law of the State for which it is used and that if any portion of this agreement is held invalid, it is agreed that the balance of the agreement shall continue in full force and effect and that whatever portion is held invalid shall be interpreted and construed to afford as much protection to H4L LLC as permitted by the applicable*

I, the undersigned, hereby grant H4L LLC the absolute right and permission to use my photograph(s) in any manner or media, including, but not limited to, the following purposes: Educational materials, Publications, Advertising and promotional materials, Social media platforms, Websites, Press releases. I hereby release and discharge H4L LLC, its employees, agents, and representatives from any and all claims, demands, or causes of action that I may have now or in the future for defamation, invasion of privacy, or violation of the right of publicity or any other right arising out of or relating to the use of the photograph(s).*

Payment Methods

Choose from one of the PayPal options to make your payment.

New Customer Registration Form