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The Vibe Dance Center LLC Assumption of Risk and Waiver of Liability Relating to Corona Virus/Covid-19

 

 

The Vibe Dance Center LLC Assumption of Risk and Waiver of Liability Relating to Corona Virus/Covid-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to be spread mainly from person to person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. 

The Vibe Dance Center, LLC has put in place preventative measures to reduce the spread of COVID-19; however, cannot guarantee that you or your child(ren) will not become infected with COVID-19. 

I attest that I am at least 18 years of age or the legal parent/guardian of the referenced minor for this waiver.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending The Vibe Dance Center LLC and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at The Vibe Dance Center may result from the actions, omissions, or negligence of myself and others, including, but not limited to, The Vibe Dance Center LLC employees, volunteers, and programs participants and their families. 

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance or participation in The Vibe Dance Center LLC’s programs (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sure, discharge, liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of The VIbe Dance Center, LLC, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any The Vibe Dance Center LLC program. 

I agree to not enter The Vibe Dance Center LLC  for at least 2 weeks (and keep children/participants under the age of 18 home) if I/they show any symptoms related to COVID-19(or if exposed to anyone with symptoms of COVID-19 in the last 2 weeks) including (but not limited to): Fever or chills, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. 

I agree to follow any and all Safety and Health Guidelines, Policies and Procedures put into place by The Vibe Dance Center. 

 

First Dancer's Name

First Name*

Last Name*

Phone*
First Dancer's Date of Birth*
First Dancer's Signature*
Second Dancer's Name

First Name*

Last Name*
Second Dancer's Date of Birth*
Third Dancer's Name

First Name*

Last Name*
Third Dancer's Date of Birth*
Fourth Dancer's Name

First Name*

Last Name*
Fourth Dancer's Date of Birth*
Fifth Dancer's Name

First Name*

Last Name*
Fifth Dancer's Date of Birth*
Sixth Dancer's Name

First Name*

Last Name*
Sixth Dancer's Date of Birth*
Seventh Dancer's Name

First Name*

Last Name*
Seventh Dancer's Date of Birth*
Eighth Dancer's Name

First Name*

Last Name*
Eighth Dancer's Date of Birth*
Ninth Dancer's Name

First Name*

Last Name*
Ninth Dancer's Date of Birth*
Tenth Dancer's Name

First Name*

Last Name*
Tenth Dancer's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Any Allergies or Medical Conditions our staff and instructors need to be aware of?

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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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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