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Rainier Dance Center – 2021-22 COVID-19 Waiver

I verify that my dancer does not have any of the symptoms below, and has not come in contact with anyone who has shown signs of any of the below symptoms, that is not attributable to another condition, in the past 14 days.

COVID-19 symptoms:

  • Fever or chills
  • Cough, shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea, vomiting or diarrhea

I Agree


RELEASE OF LIABILITY - READ BEFORE SIGNING 

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT: In consideration of being allowed to participate on behalf of Rainier Dance Center and related in-person dance classes, events and activities, the undersigned acknowledges, appreciates, and agrees that:

  1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While strict 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, and my dancer, willingly agree to comply with the stated and customary safety procedures, terms and conditions for participation as regards protection against infectious diseases. If, however, I or my dancer observe any unusual or significant hazard during my presence or participation, or if I, or my dancer are not able to follow the policies and conditions for participation, I, or my dancer, will remove themselves from participation and bring such to the attention of the nearest RDC teacher immediately or will be removed by RDC staff; and,
  4. I, for myself and on behalf of my dancer/heirs, assigns personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Rainier Dance Center, their officers, officials, agents, and/or employees, other participants, and if applicable, owners and/or 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.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

I Agree
 

First Dancer's Name

First Name*

Last Name*
First Dancer's Date of Birth*
I certify that I am 18 years of age or older
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.
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward.
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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