Dance Class Registration & Liability Waiver

Dance Class Registration & Liability Waiver

Complete your details, review the waiver text, and sign electronically; add a parent/guardian signature if you’re under 18.
Student's Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dance Experience Level
Form of Dance
Years of Experience in This Dance Form
Class Format Preference
Class Decorum & Dress Code

Please wear proper dance attire suitable for movement and practice. Approved dress code: salwar with dupatta or a practice saree.
DANCE CLASS LIABILITY WAIVER & RELEASE

ASSUMPTION OF RISK:

I, the undersigned participant (or parent/legal guardian if under 18), understand and acknowledge that participation in dance instruction, rehearsals, performances, and related physical activities instructed by Shivakanya Natyalaya LLC—whether conducted IN-PERSON or ONLINE/VIRTUALLY—involves inherent physical risks. For online instruction, I acknowledge that I am responsible for providing a safe physical environment free of hazards, suitable flooring, and adequate space. Inherent risks include, but are not limited to: muscle strains, sprains, joint injuries, slips, falls, collision with surroundings/furniture, and physical contact with other participants or studio equipment. I voluntarily choose to participate with full knowledge of these risks.

RELEASE OF LIABILITY & COVENANT NOT TO SUE:

To the fullest extent permitted by law, I hereby release, waive, discharge, and agree not to sue Shivakanya Natyalaya LLC, its owners, instructors, independent contractors, and representatives from any and all liability, claims, or demands arising out of injury, property damage, or loss sustained during in-person or online participation, whether caused by ordinary negligence or otherwise.

HEALTH DECLARATION & EMERGENCY MEDICAL CARE:

I confirm that I am (or my child is) physically fit to participate in dance activities. In the event of an in-person medical emergency where I cannot be reached or give immediate consent, I authorize Shivakanya Natyalaya to seek emergency medical treatment on my behalf. I agree to be financially responsible for any medical costs incurred.
I agree to the Photo/Video/Media Release
Is the participant under 18 years old?
Participant's Signature
Parent/Guardian Signature (Required if participant is under 18)
Parent/Guardian Name
Date Signed by Parent/Guardian

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: