Please read this form carefully. Be aware that in registering yourself or your minor child in any dance or fitness class with Rivers Dance Arts, you will be waiving and releasing all claims for injuries you or your minor child might sustain arising from participating in such activities.
I recognize and acknowledge that there are certain risks of physical injury to participants in classes with Rivers Dance Arts (hereafter referred to as RDA), and I agree to assume full risk of injuries, damages, or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities at RDA.
By my signature below, I certify that I and/or my minor child are physically able to participate in classes and do hereby agree that this business, owners, employers, contractors, assistants or agents are not responsible or liable to me for any injury, accident, or loss of personal property. I, for myself and my minor child, do hereby release this business and its employees, contractors, assistants, owners and agents from any claim or cause of action which may have occurred as a result of participation in classes or as a result of any medical problem known or unknown of which I have knowledge presently or in the future. I agree to waive and relinquish all claims that my minor child or I may have against RDA and its owners, agents, employees, contractors, instructors, and assistants as a result of participating in classes at RDA.
I further agree to indemnify and hold harmless and defend RDA, and its owners, agents, employees, contractors, instructors, and assistants from any and all claims resulting from injuries, damages and losses sustained by me or my minor child arising out of, connected with, or in any way associated with classes at RDA.
In the event of an emergency, I authorize RDA or its agents to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for me or my minor child's immediate care and agree that I will be responsible for payment of all hospital and medical charges which are incurred. I recognize and acknowledge that RDA or its agents will not be responsible for honoring specific hospital or healthcare provider preferences.
I hereby give RDA the absolute right and permission to use my and/or my minor child's name, image, interview, performance or other auditory or visual image as a RDA participant and copyright and/or publish, or use pictures, or videotapes, of me and/or my minor child of which the inclusion is in whole or in part, made through any media or Internet website at its studios or elsewhere, for research, education, advertising, trade or any other lawful purpose whatsoever, pertaining to RDA, whether taken in the classroom, prior to, or after class, at a Studio event, or a dance performance, dress rehearsal, or dance recital and whether these events are within, pre, or post the enrolled semester. I hereby waive any right that I may have to inspect and/or approve the finished product that may be used in connection therewith, or the use to which it may be applied.
I have read and fully understand the above Waiver and Release of All Claims and Permission to Secure Treatment.