Registration Form for WCS at Fredericksburg Yoga & Wellness, Wednesdays 7-8:30 pm, March 11 through April 15, 2026

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Mané and Roger Dance Teachers LLC Liability Release

MANÉ AND ROGER DANCE TEACHERS LLC LIABILITY RELEASE&#13;&#10;&#13;&#10;I choose to participate in classes, performances, workshops, and other activities with Mané and Roger Dance Teachers LLC of my own free will and certify that I am in proper physical condition to take part in such activities. If I have questions about whether an activity is suitable for me to pursue, I will consult my healthcare provider in making that decision. If I have any known physical vulnerabilities, conditions, or injuries, I agree to discuss them with my instructor before participating.&#13;&#10;&#13;&#10;Release&#13;&#10;&#13;&#10;By signing this document, I release Mané and Roger Dance Teachers LLC and its owners, students, teachers, staff, employees, volunteers, associates (collectively referred to in this document as Mané and Roger Dance Teachers LLC) from any liability or claim that I or my representatives may have against Mané and Roger Dance Teachers LLC with respect to any bodily injury, personal injury, illness, death, or property loss or damage that may result from my participation with Mané and Roger Dance Teachers LLC. I voluntarily release and forever discharge and hold harmless Mané and Roger Dance Teachers LLC from any and all claims or demands for damages, loss of services, costs and expenses, injuries, attorney fees, and any other call for reparation from any and all injury to me or my property arising in any way from my participation in dance lessons, classes, intensives, workshops, performances, the use of Mané and Roger Dance Teachers LLC’s equipment or facilities, and any activities associated with Mané and Roger Dance Teachers LLC.&#13;&#10;&#13;&#10;Risks&#13;&#10;&#13;&#10;I understand that there are risks of physical injury associated with, arising out of, and inherent to dancing. These risks include the potential for slips and falls, sprains, strains, dislocations, soft tissue injuries, musculoskeletal injuries, podiatric conditions, and other risks not specified here. Understanding these risks and the potential for others not listed, I agree to personally accept and assume all the risks present in my participation with Mané and Roger Dance Teachers LLC. My participation with Mané and Roger Dance Teachers LLC is entirely voluntary, and I choose to participate despite the risks. Dance education sometimes requires hands-on instruction as well as verbal instruction. Instructors may correct dancers by touching their arms, legs, feet, hips, back, and head to move them in the correct position. I acknowledge that this is a common standard in dance instruction and understand that it is my responsibility to communicate clearly with my teacher and/or the director if any form of touch is unacceptable to me.&#13;&#10;&#13;&#10;Medical Treatment and Insurance&#13;&#10;&#13;&#10;I understand that Mané and Roger Dance Teachers LLC do not assume any responsibility for or obligation to provide financial or other assistance in the event of injury or illness, including but not limited to medical, health, or disability insurance or support. I authorize Mané and Roger Dance Teachers LLC to obtain necessary medical or dental treatment, including first aid, ambulance transport, hospitalization, or other such care necessary for my health and welfare in an emergency. If my insurance does not cover emergency treatment that is deemed necessary and sought for me by Mané and Roger Dance Teachers LLC, I agree to be responsible for and pay all costs incurred on my behalf. I release and discharge Mané and Roger Dance Teachers LLC from any claim that may arise on account of any first aid, treatment, or service rendered in connection with my participation in Mané and Roger Dance Teachers LLC’s activities or with the decision by any representative or agent of Mané and Roger Dance Teachers LLC to consent to medical or dental treatment on my behalf in an emergency. I understand that Mané and Roger Dance Teachers LLC do not carry or maintain health, medical, dental, or disability insurance coverage for any participant. I agree to take responsibility for full payment of any emergency medical or dental costs related to my participation with Mané and Roger Dance Teachers LLC regardless of whether I have insurance coverage.&#13;&#10;&#13;&#10;Photographic Release&#13;&#10;&#13;&#10;I understand that Mané and Roger Dance Teachers LLC may take photo and video recordings of me during my participation in Mané and Roger Dance Teachers LLC’s lessons, classes, and activities. I convey to Mané and Roger Dance Teachers LLC full rights and interest in these recordings. I understand such recordings may be used in advertising or other published materials, physical or virtual. If I do NOT consent to being photographed or video-recorded, I will make sure my instructor is aware of my preference, I will be proactive about avoiding being photographed or recorded, and I will hold Mané and Roger Dance Teachers LLC harmless if a photo or video recording of me is released despite all precautions. I understand that this choice may limit my participation in performances that are routinely photographed and/or videotaped.&#13;&#10;

I agree to the Mané and Roger Dance Teachers LLC Liability Release*

Fredericksburg Yoga & Wellness Acknowledgement, Release and Waiver of Liability

ShredAcre, LLC (d.b.a. Fredericksburg Yoga & Wellness)&#13;&#10;Acknowledgement, Release and Waiver of Liability&#13;&#10;&#13;&#10;In consideration for being permitted to enter and use the facilities of ShredAcre, LLC (d.b.a. Fredericksburg Yoga & Wellness) for dance rehearsals, instruction, performances, classes, or related activities, I hereby agree to release, indemnify, and hold harmless ShredAcre, LLC, its members, contractors, employees, agents, and any other persons or entities acting for or through them, from and against any and all liability for damage or injury to persons or property.&#13;&#10;&#13;&#10;I understand and agree to the following:&#13;&#10;&#13;&#10;1. Dance & Dance-Related Activities Involve Risk&#13;&#10;&#13;&#10;I understand that dance, movement, choreography, and related physical activities—along with the use of the studio space—carry inherent risks of physical injury, severe or otherwise. These risks include, but are not limited to:&#13;&#10;&#13;&#10;• Slipping, falling, or collisions&#13;&#10;• Muscle strain, sprains, fatigue, or overexertion&#13;&#10;• Injuries from choreography, lifts, turns, or floor work&#13;&#10;• Injuries arising from the condition of the facilities&#13;&#10;• Any other known or unforeseen physical harm&#13;&#10;&#13;&#10;In recognition of these risks, I knowingly and voluntarily waive any and all rights or causes of action of any kind, including claims of negligence, that could accrue to ShredAcre, LLC, its officers, agents, employees, instructors, or affiliated persons or entities (collectively referred to as “ShredAcre, LLC”).&#13;&#10;&#13;&#10;2. Assumption of Risk&#13;&#10;&#13;&#10;I knowingly and voluntarily assume full responsibility for all risks of injury that may occur from my participation in any dance or dance-related activities, whether active or passive, and I agree to hold ShredAcre, LLC harmless from any liability arising out of such participation.&#13;&#10;&#13;&#10;3. Physical Capability to Participate&#13;&#10;&#13;&#10;I certify that:&#13;&#10;&#13;&#10;• I am healthy and capable of participating safely in dance activities.&#13;&#10;• I have no physical or mental condition that would restrict or endanger my participation.&#13;&#10;• I understand that ShredAcre, LLC does not provide medical advice or treatment.&#13;&#10;• I understand that ShredAcre, LLC recommends consulting a physician before engaging in any exercise or dance program.&#13;&#10;• I am responsible for informing ShredAcre, LLC of any pain or injury experienced before, during, or after activities.&#13;&#10;• I have adequate insurance to cover any injury or damage I may suffer or cause, or I agree to bear those costs myself.&#13;&#10;&#13;&#10;4. Media Release & Surveillance Notice&#13;&#10;&#13;&#10;I agree that my image—and/or the image of my minor child—whether recorded or live, may be used or shown on Fredericksburg Yoga & Wellness’ website or social media (including Facebook, Instagram, YouTube, etc.).&#13;&#10;&#13;&#10;I acknowledge that the facility is under 24/7 audio and video surveillance for security and training purposes, and I consent to this recording.&#13;&#10;&#13;&#10;5. Governing Law&#13;&#10;&#13;&#10;This Agreement shall be governed by the laws of the Commonwealth of Virginia.&#13;&#10;&#13;&#10;6. Severability&#13;&#10;&#13;&#10;If any portion of this Release and Waiver is held invalid, unenforceable, or void by a court of competent jurisdiction, the remainder shall remain in full force and effect.&#13;&#10;&#13;&#10;I acknowledge that I have read and fully understand this Facility Use Waiver and Release of Liability. I understand that by signing it, I am giving up substantial legal rights and I am signing voluntarily, without inducement or guarantee, intending this to be a complete and unconditional release of liability to the fullest extent allowed by law.&#13;&#10;&#13;&#10;

I agree to the Fredericksburg Yoga & Wellness Acknowledgement, Release and Waiver of Liability*

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West Coast Swing Dance Basic Beginner Series at Fredericksburg Yoga & Wellness

Wednesdays 7–8:30 pm six-week introductory West Coast Swing series at Fredericksburg Yoga & Wellness, March 11 through April 15, 2026

$120.00 Quantity

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