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Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement for a Minor

NOTICE TO THE MINOR CHILD’S PARENT AND/OR GUARDIAN: READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF ALPINE DANCE ACADEMY USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM ALPINE DANCE ACADEMY IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND ALPINE DANCE ACADEMY HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. This Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement for a Minor (this “Release”) by and between the undersigned and ALPINE DANCE ACADEMY and its shareholders, managers, employees, officers, agents, affiliates, and assigns (collectively, “ALPINE DANCE ACADEMY and together with undersigned referred to as “the parties”) is effective from today’s date and will remain in full force and effect at all times now and in the future. If this Release and Waiver is revoked by the Parent and/or Guardian on behalf of the Child/Participant, the revocation must be in writing hand-delivered to Alpine Dance Academy and shall only apply to injury or damage occurring after the date of revocation; Alpine Dance Academy reserves the right to terminate Child’s/Participant’s Activities in case of revocation of this Release and Waiver.

1. The Parent and/or Guardian fully understands and acknowledges is choosing to allow Child/Participant to participate in any and all available recreational activities, provided herein, offered by Alpine Dance Academy; and undersigned fully understands and acknowledges that there are inherent risks and dangers associated with participation in dance, tumbling and gymnastics, travel to-and-from events and activities, general play activities and/or any other activity provided for Child/Participant by Alpine Dance Academy (the “Activity” or “Activities”) and that the Parent and/or Guardian has voluntarily chosen to allow Participant to participate in such Activities. Risks include, but are not limited to, property damage, mental/emotional injury, broken bones, strains, sprains, bruises, drowning, concussion, heart attack, heat exhaustion. other permanent or temporary bodily injury, disability and/or death. These risks and dangers may be either be inherent in the Activities and/or may be caused by Child/Participant, other participants, and/or the owners, staff and volunteers of Alpine Dance Academy. Particular risks include, but are not limited to: falling; slick or uneven surfaces; variations in terrain; design and condition of man-made facilities, equipment and toys; collisions with other participants and staff; equipment and toy failure, malfunction, or misuse; (in case of vehicular travel) collisions or encounters with motor vehicles; other children/participants; lack of supervision; (in case meals are provided) food-borne allergies or illnesses; and limited access to and/or delay of medical attention. This description of the dangers and risks listed above is not complete and that participating in the Activities may be dangerous and may include other risks, including, but not limited to the acts, omissions, representations, carelessness, and negligence of Alpine Dance Academy. Further, there may be risks not known to the undersigned or reasonably foreseeable at the time of the Activities. The Parent and/or Guardian has been informed of and understands and has considered the inherent risks involved and voluntarily and freely chooses to assume those inherent risks.

2. The Parent and/or Guardian acknowledges is the solely responsible to ensure that the Child/Participant participates only in those activities for which he/she has prerequisite skills, qualifications, preparations and training; and represents that the Child/Participant is physically and mentally fit to participate in the Activities, has no current or past medical condition (including but not limited to heart or hearing conditions, back problems, seizures, paralysis, restrictive use of arms or legs. If at any time the Child/Participant is no longer in proper physical condition to participate in the Activities, Parent and/or Guardian will immediately discontinue Child’s/Participant’s further participation in the Activities.

3. The Parent and/or Guardian understands and agrees that while participating in the Activities, Participant may be filmed or photographed; and thereupon grants Alpine Dance Academy, without limitation, the right to use Child’s/Participant’s name and likeness in connection with the Activities for any publicity without compensation or permission.

4. The Parent and/or Guardian acknowledges that Alpine Dance Academy does not warrant or guarantee in any respect the competency or mental or physical condition of any instructor, trip leader, vehicle driver or other child/participant to care for the Child/Participant

5. The Parent and/or Guardian authorizes Alpine Dance Academy to call for medical care for Child/Participant or to transport Child/Participant to a medical facility or hospital if, in their opinion, medical attention is needed. I agree to pay all costs associated with such medical care and related transportation. FURTHER, THE WAIVER AND RELEASE OF LIABILITY SET FORTH BELOW SHALL APPLY IF, IN THE EXERCISE OF GOOD FAITH, ALPINE DANCE ACADEMY FAILS TO PROVIDE AND/OR ARRANGE FOR MEDICAL CARE OF THE CHILD/PARTICIPANT.

6. The Parent and/or Guardian authorizes the Alpine Dance Academy to provide food and drink to the Child/Participant. FURTHER, AND NOTWITHSTANDING THE IDENTIFICATION OF ANY FOOD ALLERGIES AND DIETARY RESTRICTIONS, THE WAIVER AND RELEASE OF LIABILITY SET FORTH BELOW SHALL APPLY IF, IN THE EXERCISE OF GOOD FAITH, ALPINE DANCE ACADEMY FAILS TO ACCOMMODATE THE FOOD ALLERGIES AND SPECIAL DIETARY REQUIREMENTS OF THE CHILD/PARTICIPANT, EVEN IF ENUMERATED ABOVE.

7. The Parent and/or Guardian understands and agrees that with respect to TODDLER AND “MESSY PLAY” ACTIVITIES FOR CHILDREN UNDER AGE 5, Alpine Dance Academy does not provide supervision of any individual Child/Participant. Children participating in such activities are to be accompanied and supervised by a responsible adult that may include, but not be limited to, the Child’s/Participant’s parents, legal guardians, and other adults as authorized by the Parent/Guardian.

RELEASE, WAIVER OF LIABILITY AND COVENENT NOT TO SUE - READ CAREFULLY BEFORE SIGNING

THE NAMED PARENT AND/OR GUARDIAN, HIS/HER OWN BEHALF AND ON BEHALF OF CHILD/PARTICIPANT, ACKNOWLEDGE THE RISKS AND DANGERS ASSOCIATED WITH THE ACTIVITIES AND AGREE TO (1) ASSUME ANY AND ALL RISKS OF INJURY OR DEATH TO CHILD/PARTICIPANT RESULTING FROM PARTICIPATION IN ANY ACTIVITIES; (2) WAIVE, RELEASE, AND NOT SUE OR FILE ANY ACTIONS OR CLAIMS AGAINST ALPINE DANCE ACADEMY THAT ARE BASED ON, ARISE OR RESULT FROM, IN WHOLE OR IN PART, PARTICIPATION IN ANY ACTIVITIES, INCLUDING, BUT NOT LIMITED TO NEGLIGENCE AND PREMISES LIABILITY CLAIMS; (3) INDEMNIFY, DEFEND, AND HOLD HARMLESS THE ALPINE DANCE ACADEMY FROM AND AGAINST ANY LIABILITY OR DAMAGE OF ANY KIND AND FROM ANY SUITS, CLAIMS OR DEMANDS, INCLUDING LEGAL FEES AND EXPENSES WHETHER OR NOT IN LITIGATION, ARISING OUT OF, OR RELATED TO, PARTICIPANT’S PARTICIPATION IN THE ACTIVITIES. For purposes of this Release, the term “Alpine Dance Academy” includes Alpine Dance Academy, a Colorado corporation, as well as its and its shareholders, managers, employees, officers, agents, affiliates, and assigns.

Today's Date: December 10, 2019

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Food Allergies:

Special Diets:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Food Allergies:

Special Diets:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Food Allergies:

Special Diets:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Food Allergies:

Special Diets:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Food Allergies:

Special Diets:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Food Allergies:

Special Diets:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Food Allergies:

Special Diets:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Food Allergies:

Special Diets:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Food Allergies:

Special Diets:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Food Allergies:

Special Diets:
Parent or Guardian's Email Address

Email*

Confirm Email*
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The above-named child’s/participant’s parent represents that he/she is one of the following persons authorized to release or waive the child's prospective claim for negligence pursuant to C.R.S § 13-22-107: (i) a parent, as defined in section 19-1-103 (82), C.R.S. (ii) a person who has guardianship of the person, as defined in section 19-1-103 (60), C.R.S., (iii) a person who has legal custody, as defined in section 19-1-103 (73), C.R.S., (iv) a legal representative, as defined in section 19-1-103 (73.5), C.R.S., (v) a physical custodian, as defined in section 19-1-103 (84), C.R.S., or (vi) or a responsible person, as defined in section 19-1-103 (94), C.R.S.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Food Allergies:

Special Diets:
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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