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LIABILITY RELEASE/WAIVER FORM 

 

All participants and students must complete this form before participating in any classes or rehearsals at Ntrinsik Studios. If the participant is under age 18,  a parent or guardian must also sign this form. Admission to class, and/or rehearsal will not be granted if this form is not received prior to the date of the class and/or rehearsal,  and if this form is not properly signed.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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.
Waiver of Liability

I, recognize and understand the risks of physical injury inherent to dance and dance training and I fully assume those risks. I hereby release Ntrinsik Studios of Ntrinsik Movement LLC, and its employees and dance teachers from all liability for injuries sustained or illnesses contracted while attending or participating in any dance classes, rehearsals, workshops, or performances. I agree to indemnify, defend, and hold harmless Ntrinsik Studios of Ntrinsik Movement LLC, its affiliate dance studios, event sponsors, employees and dance teachers for liabilities, costs and judgments arising from acts of omissions committed by me or my child which result in injury or damage to any person or property.


Signature *

Parent/Guardian Signature (if under 18)
Protection of Property

I, understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in any classes, rehearsals, workshops, or performances. I hereby release Ntrinsik Studios of Ntrinsik Movement LLC, its affiliate dance studios, event sponsors, employees and dance teachers from all liability for loss or damage to my personal property while attending or participating in classes, rehearsals, workshops, or performances. I also agree to abide by any rules, regulations and policies set forth by Ntrinsik Studios.


Signature *

Parent/Guardian Signature (if under 18)
Medical Attention

In case of physical injury or medical emergency, I hereby authorize Ntrinsik Studios of Ntrinsik Movement LLC to make necessary arrangements to transport myself or my child to a medical treatment facility as necessary. All such transportation and medical treatment will be at my sole cost and expense. In an extreme emergency, or if my child is under 18 years of age, I understand that Ntrinsik Studios of Ntrinsik Movement LLC will attempt to notify the person(s) I have named below as my emergency contact(s) of my condition and how to reach me.


Signature *

Parent/Guardian Signature (if under 18)

Emergency Contact Name

Emergency Contact Number

Emergency Contact Name

Emergency Contact Number
Media Release

Ntrinsik Studios of Ntrinsik Movement LLC reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting Ntrinsik Studios and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify Ntrinsik Studios prior to participation in class.


Signature *

Parent/Guardian Signature (if under 18)
Acknowledgement of Waiver

In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and am fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my or my child's participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me or my child.


Name of Participant *

Signature of Participant *

Signature of Parent/Guardian (if under 18)

Name of Parent/Guardian (if under 18)

Date *
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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