Loading...

SUMMER 2021

Injury Waiver & Consent to Participate
In Addition to Covid Safety & Distancing Liability Form

 

At Step 1 Dance 2 Academy , we are following strict

social distancing + cleaning protocols. As any other

public place we cannot guarantee that your child will

not be exposed (whether at Step 1 Dance 2 Academy or

elsewhere) or if exposed, that your child will not

contract the illness.

 

I adhere to the safety protocols listed by

Step 1 Dance 2 Academy.

By signing this Liability and Covid Form 

 you agree to

waive any claims of liability against Step 1

Dance 2 Academy and to hold Step 1 Dance

2 Academy harmless if your child contracts

COVID-19 despite our best efforts to

prevent it. Additionally, I agree to notify

Step 1 Dance 2 Academy if my child or any

member of our household contracts COVID-

19 or has come into contact with someone

who tested positive for COVID-19. This

action will help ensure the utmost safety

of our dancers & staff.

The named dancer has permission to participate fully in all aspects of the dance program. In consideration of participating in the dance programs at Step 1 Dance 2 Academy, the dancer and/or parent/legal guardian of the dancer named have agreed:

1. To accept all rules of Step 1 Dance 2 Academy as outlined in this document and will be responsible to make payments as described thru our online studio portal and as stated in Tuition Contract. Any payments missed, can and will be reported to crediting bureau.


 

2. To allow photographs and video of my child, during scheduled dance activities, to be used for promotional purposes. (For their safety, children’s names will not be published or posted with photos.)


 

3. To monitor behavior of participants, siblings, and guests while in public areas of the studio, i.e. while waiting for class inside and near/outside of studio facility.


 

4. I/We agree understand that due to the physical nature of dance, there may be physical contact between Staff Members, Proteges, contracted Guest Choreographers and students during regular class instruction (in regards to adjustments to alignment and form), when taking measurements for costumes, checking the fit of costumes, and backstage during our Spring Showcase performances, should your child happen to have a quick change and need assistance.


 

5. I/We fully understand that:

​a. There are risks and dangers associated with participation in dance events and classes including but not limited to bodily injuries, and/or partial and/or total disability;
b. The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe;
c. These risks and dangers may be caused by the negligence of the participant or the negligence of others;
d. I/We accept and assume such risks and responsibility for the loss and/or damages following such injury or disability, however caused or alleged to be caused while or in part by the negligence of Step 1 Dance 2 Academy, other participants, instructors, sponsors, directors, event hosts, agents, and employees. I/We further will not hold Jessica M. Gallew, her assigns, or heirs responsible for losses and/or damages as mentioned above.


 

6. I/We agree that this Consent and Assumption of Risk and Safety Statement covers each and every event and every activity by Step 1 Dance 2 Academy.


 

I/WE HAVE READ THE ABOVE WAIVER AND SIGN IT VOLUNTARILY.

IF THE NAMED DANCER IS CONSIDERED TO BE A MINOR (UNDER 18 YEARS OF AGE), THE FORM MUST BE SIGNED BY A PARENT/LEGAL GUARDIAN.

Today's Date: June 14, 2021

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 Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!