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Student Liability Waiver

I understand there are no refunds for cancellation of lessons and lessons are not transferable.

I Agree

I understand there is a 24 hr cancellation policy for private lessons.

I Agree

Privacy Policy: 

It is our policy to protect the privacy of our clients.  Your information will never be given out to any other 3rd person or party, and will only be used 1) As necessary for normal business conduct; 2) to conform to the edicts of the law or comply with legal process served on us; 3) to prevent or stop any activity we may consider to be, or to pose a risk of being, illegal, unethical, inappropriate or legally actionable;   and 4) as you elect for studio updates and information.

Photo & Video Release:

I am aware that pictures and/or video of me may be taken at the DioAmore Dance & Fitness Studio and/or at outside events for the studio.

I hereby grant DioAmore Dance & Fitness Studio permission to use my likeness in photograph, video or other digital reproduction in any and all of its promotional materials, including website entries, without payment or any other consideration.

I hereby irrevocably authorize the DioAmore Dance & Fitness Studio to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the business or for any other lawful purpose.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.  I hereby hold harmless and release and forever discharge DioAmore Dance & Fitness Studio from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Participation Disclaimer:

Before starting, stopping, or changing any part of a health care plan, including physical activities like dance and fitness, you should always consult with a medical professional first. DioAmore and its affiliates are not a suitable or proper replacement for medical advice regarding your personal health condition. As always, please use common sense regarding your health and fitness. If a movement is not appropriate for you, modify as necessary, or discontinue, and if you experience any adverse changes in your health, contact a medical professional as soon as possible. 

Release of Liability:

I understand this release of liability shall include any and all events held in or outside of the DioAmore Dance & Fitness Studio in which I participate in as part of studio functions whether or not it is dance or fitness related.

I understand that there are risks of physical injury associated with, arising out of, and inherent to the activity of dance and fitness. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/ or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to DioAmore Dance & Fitness Studio, and all affiliated entities (hereinafter collectively referred to as DioAmore Dance & Fitness Studio).

I hereby agree to release and hold DioAmore Dance & Fitness Studio harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in dance, fitness and/or other studio activities, whether in the studio or at any other location, on behalf of the participant.

I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury.  I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.

If I am a minor, my parent and/or legal guardian has also signed this document releasing DioAmore Dance & Fitness Studio from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
I would like to receive the Monthly Email Newsletter
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Can be reached by text message?
Yes
No
How did you hear about the studio?*
Referral
Internet Search
Dancing in Public
Advertisement
Yelp
Other

Any conditions we should be aware of or anything else you'd like us to know?
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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