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WAIVER/RELEASE

I understand and agree that in participating in any class, workshop, rehearsal, party, performances, or activities, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me during any of the Georgia Chrome Star, LLC, in-studio classes, online classes, pole series, studio rentals, private/semi-private lessons, rehearsals, workshops, parties, performances, or activities. I also exempt, release, and indemnify Georgia Chrome Star, its owners, agents, volunteers, assistants, employees, instructors, guest instructors, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, or property which may arise out of or in connection with participation in any classes or activities conducted by Georgia Chrome Star, LLC. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Georgia Chrome Star, its owners, agents, volunteers, assistants, employees, instructors, guest instructors, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them.

Permission is granted to Georgia Chrome Star to use photographs & video recording of students for publicity purposes.

I agree that Georgia Chrome Star is in no way responsible for the safekeeping of my personal belongings while I attend class.

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

In consideration of being allowed to participate on behalf of Georgia Chrome Star, LLC workout programs and related events and activities, I acknowledge, appreciate, and agree that:

  1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
  2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
  3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases; and,
  4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Georgia Chrome Star, LLC) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
  5. I affirm that I, as well as anyone in my household, have not been diagnosed with COVID-19 in the past 30 days & should I be diagnosed, will not attend any classes/events until cleared by a doctor.
  6. I affirm that I, as well as anyone in my household, have not knowingly been exposed to someone diagnosed with COVID-19 in the last 30 days and if I should be exposed at anytime, I will not attend any classes/events, I will self-isolate and not attend any classes/events until I have been cleared by a doctor. 
  7. I understand that Georgia Chrome Star, LLC and the instructors/trainers have implemented recommended disinfection protocols, however the risk of infection of COVID-19 still exists and by attending classes and events, I acknowledge that risk and will not hold Georgia Chrome Star, LLC, accountable.

Date: January 23, 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*
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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*
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.


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