Release and Waiver of Liability
DANCE STUDIO B
200 Nash Street E
Wilson, NC 27893
(252)291-3363
FOR AND IN PARTIAL CONSIDERATION of the admission of the named student to classes and instruction at DANCE STUDIO B, Wilson, North Carolina, the named, as student, or as parent and/or legal guardian for the named student, if a minor, hereby acknowledges and agrees that the dance classes and instructions for which the named student has been enrolled constitutes physical exercise and activity which could subject the named student to physical injury. The named student is in good health and is aware of no medical reason that such student should not participate in the dance classes and instructions for which the student has been enrolled, and accordingly:
The named student, for and on behalf of herself/himself, or if a minor, the named student, his personal representatives, heirs and other next of kin, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Dance Studio B, its shareholders, officers, directors, employees, or its agents, from any and all liability to the named student, his/her personal representatives, assigns, heirs, and other next of kin for any and all loss or damage and any claim or demands therefore on account of injury to the named student, for whatever reason, occurring, directly or indirectly, while the named student is participating in any and all recitals given in connection therewith, and any travel to or from such classes or instructions.
The named student or legal guardian of the named student who has registered in classes with Dance Studio B, does hereby grant authority to the staff of Dance Studio B, to render a judgment concerning medical assistance in the event of an accident or illness during my (the undersigned) absence. The named student or legal guardian of the named student does hereby authorize simple first aid, medical or surgical diagnosis which is deemed necessary.
THE NAMED STUDENT, OR HIS/HER LEGAL GUARDIAN, HAS READ AND HEREBY VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY TO DANCE STUDIO B FOR THE ADMISSION OF THE NAMED STUDENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.
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If named student, or his/her legal guardian is in agreement with the terms of this release and waiver of liability, he or she shall type his/her full name in the appropriate field on the enrollment form.