INSTRUCTIONS: -Please read the following Release Form, and print the Parent or Legal Guardian’s Name and the date in the signature space.
1.) RISK FACTORS
I, The undersigned, understand and agree that participation in trials, training, use of facilities, travel and / or service projects and actions and all other programs and services sponsored by Leah Willis Dance Arts (LWDA) or its associated auxiliary involves risks such as, but not limited to, the following, which could result from the Student’s use of equipment or facilities, from the activity itself, the acts of others, or lack of emergency care or emergency medical care: an injury, illness, death and loss or damage which the Student may suffer as a result of his / her participation in these activities.
2.) ASSUMPTION OF RISK.
I, the undersigned, agree and sustain the LWDA Program, its directors, employees, affiliates, auxiliary and volunteers blameless and waive the right to sue for all risks arising from the Student’s use of the equipment or facilities, the activity itself, other acts, or lack of availability of emergency care for the Student including but not limited to, the risk factors described in paragraph 1 above.
3.) DISCLAIMER.
I, the undersigned, waive the protection afforded by any statute or law in any jurisdiction and agree to hold harmless the States of California and Nevada, Leah Willis Dance Arts Non-profit Corporation, auxiliary organizations, officials, employees , volunteers and agents (collectively, the "Indemnitee") and agree not to sue because of or in connection with any claim, cause of action, injuries, damages, costs, expenses relating to the operation, including those based on death, personal injury or property damage or not caused by the acts, omissions or other fault of the parties being released.
4.) ACKNOWLEDGMENT OF POLICIES AND PROCEDURES.
I, the undersigned, acknowledge reading and knowing all of the Policies and Procedures Relating to the Activities, facilities, and / or equipment and understand that the safe and proper use of the facilities, equipment or participation in the activity is dependent upon the Student following carefully such policies and procedures.
5.) PREREQUISITES AND TRAINING.
I, the undersigned, acknowledge that the Student possesses moderate skills, experience, physical and mental ability, and training necessary for the proper and safe use of equipment and facilities and participate in the training, discipline, rehearsals and performance. The undersigned agrees that if the Student has any questions about what skills or training are required, how to properly use the equipment, facilities, or to participate in training, discipline and performance, he or she will direct those questions to appropriate personnel on site. The undersigned expressly consents to allow dance instructors of the LWDA Innovative Arts Education Program to appropriately and gently lay hands on the Student for the sole purposes of timely muscle or movement correction, dance demonstration and teaching.
6.) INDEMNIFY AND DEFEND.
I, the undersigned, agree to indemnify and defend the States of California, and Nevada, the Leah Willis Dance Arts Non-profit Corporation, subsidiary organizations, officials, employees, volunteers and agents (collectively, the "Indemnitee ") each one against, and hold them harmless from any claim or all causes of action, judgments, damages, costs or expenses, including attorneys' fees, arising in any way from this activity or this agreement, including but not limited to damage or destruction of any property of the compensation of any others, injury or death of the undersigned, the Student or any other person or any liability for the negligent act or fact of Indemnitees, the undersigned or anyone else.
7.) PAY.
I, the undersigned, agree to pay for any and all tuition expenses due, costs incurred, damage to any property where training, use of facilities, travel and / or service projects, events and services sponsored by Leah Willis Dance Arts (LWDA) or its associated auxiliary take place, damages caused by Me or the Student; negligent, intentional or otherwise.
8.) REPRESENTATIVES.
I, the undersigned, enter into this agreement for the Student, myself/himself / herself, his / her heirs, legal representatives and Allocators.
9.) EMERGENCY TREATMENT CONSENT.
I, the undersigned, as a responsible party for the student participant in the activity, consent to the professionally recommended medical treatment by EMTs or Paramedics etc., for the Student Participating in the LWDA Innovative Arts Education Program in a medical emergency where The undersigned cannot consent to such treatment.
10.) INSURANCE.
I, the undersigned is encouraged to have the Student take a physical exam and acquire or have their own medical insurance before any participation.
10A.) Liability Coverage and Guests
Regarding guests: Friends of participants, and siblings that are not registered, must stay with the participant's parent or guardian, and cannot be in class with the registered participant. Because guests and friends don't have a registration form on file, for liability reasons, and their safety, they cannot be left unattended or play in the dance space during class time. Please also remind the registered participant that any and all equipment on the facility, site or event property may not be played/tampered with. All other guests must be cleared with LWDA personnel ahead of time.
Leah Willis Dance Arts does carry Limited Liability Coverage which provides incident protection for certain damages incurred (depending on the circumstance) only for particiants who are actively enrolled in our program.
11. RECOGNITION.
I, the undersigned, have read and understand this agreement, and realize that it refers to the relinquishment of valuable legal rights and do so freely and voluntarily.