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Ballroom Connection LLC d/b/a Silver Shoes Dance Club – Liability Waiver and Photo Release Form- REMOTE CLASSES

Ballroom Connection LLC d/b/a Silver Shoes Dance Club (“Silver Shoes”) is a New York limited liability company that promotes wellness, physical fitness, and social connection within communities by teaching ballroom dance classes (the “Dance Classes”) to active senior citizens.

In exchange for the opportunity to participate in the Dance Classes, I agree as follows:

Fitness to Participate.

  • I confirm that I

    (a) am in good health and sound physical condition, and do not have any medical or other conditions that would impair or prevent my participation in the Dance Classes; and

    (b) have not been instructed by any healthcare provider (including, but not limited to doctors, physical therapists, or specialty practitioners), not to engage in physical activities, including but not limited to those that involve strength, flexibility, aerobic, cardiovascular or other exercises.
     
  • I will follow all instructions, recommendations, and cautions of Silver Shoes at all times during the Dance Classes. However, if at any time I believe conditions to be unsafe or that I am no longer able to safely participate in the Dance Classes, including but not limited to my experiencing shortness of breath, muscle fatigue, pain, or lightheadedness, I will immediately discontinue or modify as I feel appropriate my further participation in the Dance Classes.

Assumption of the Risks.

  • I acknowledge and understand that

    (a) participation in the Dance Classes involves strength, flexibility, aerobic, cardiovascular and other exercises, all of which can be potentially hazardous activities, and there are potential risks, hazards and dangers, known and unknown, associated with the foregoing activities, including but not limited to injury, illness, strains, fractures, death or serious disability (collectively, the “Risks”) and that there is a higher chance that I will experience the Risks if I am over the age of 50;

    (b) the Risks may be caused in whole or in part by my own actions, the actions of others participating in the Dance Classes, the actions or negligence of third parties (including but not limited to, virtual meeting service providers), or the acts or negligence of Silver Shoes, its affiliates, licensees, agents, officers, contractors, employees, successors and assigns and their respective founders, members, officers, agents and employees (together, the “Released Parties”);

    (c) the Risks are inherent to my participation in the Dance Classes, even with the exercise of due care by the Released Parties;

    (d) Dance Classes that are conducted remotely (including without limitation over Zoom, Google Meet, or other virtual meeting service) have certain additional inherent risks, and I understand that when Dance Classes are conducted remotely the Released Parties will be unable to (i) provide the same level of oversight and monitoring as they would if the Dance Classes were conducted in-person and (ii) assess the physical space in which I am participating for safety hazards; and

    (e) while Silver Shoes will facilitate the virtual setting for remote learning, Silver Shoes does not control the virtual meeting service (Zoom, Google Meet, etc.).
     
  • I elect to participate in the Dance Classes in spite of the Risks and expressly assume and accept all such Risks and responsibility for any damages, liabilities, losses or expenses, which I incur because of my participation in the Dance Classes.

Release of Liability, Indemnity and Waiver of Right to Sue.

  • I knowingly and voluntarily, on behalf of myself, my heirs and assigns, release, discharge, indemnify, defend and hold harmless the Released Parties, from and against, and irrevocably waive my right to sue the Released Parties for, any and all claims, liability and causes of action, which I or a third party may have, in law or in equity, against the Released Parties arising from, resulting from or in connection with, directly or indirectly, my participation in the Dance Classes, including, but without limitation, any claims, liabilities, demands or causes of action resulting, directly or indirectly, from any actualization of the Risks that occur to me or to any other person, or any property during the Dance Classes or arising, directly or indirectly, from the Dance Classes including but not limited to those resulting from the negligence (but not the gross negligence or willful misconduct) of the Released Parties.
     
  • This waiver and release is signed for the purpose of fully and completely releasing, discharging, and indemnifying, including without limitation attorneys’ fees, the Released Parties from any and all claims, liability, and causes of action, in law or in equity, as described in this waiver and release, as I, or as someone on my behalf, or as a third party may have presently or in the future.

Photo Release.

  • I authorize the Released Parties to film, photograph, and record my participation in the Dance Classes, or to permit others to do so, and to use, in any form or by any means, such photographs, video and other recordings of me, with or without my name, without payment or any other consideration, for the purpose of promotion, advertising, fundraising, and marketing, in any manner or in any medium, including, but not limited to, brochures, advertisements, newspapers, websites, videos or other materials or publications in print, audio, online (including social media platforms such as Facebook, Instagram, Twitter, etc.), electronic or visual media.
     
  • In addition, I hereby release and hold harmless the Released Parties from any reasonable expectation of privacy or confidentiality associated with the photographs, videos or recordings specified above. I voluntarily waive any right, cause of action or demand of any kind whatsoever, in law or in equity, resulting from such photographs, videos or recordings of me from which any liability may or could accrue to the Released Parties.

Miscellaneous. `

  • This waiver and release is governed by and will be construed in accordance with the laws of the State of New York. I agree that no provision of this waiver and release will be waived except specifically in a writing signed by me and Silver Shoes. I further agree that if any provision is deemed by a court unenforceable or invalid, that provision will be stricken or modified, and the remainder of this waiver and release form will remain in full force and effect.
     
  • I understand that this waiver and release represents the entire agreement and understanding between me and the Released Parties with respect to the waiver and release of liability.

I have read this waiver and release before signing below and I understand its contents, meaning and impact. I understand that by signing this waiver and release that I will release, discharge and waive rights I would otherwise have. 

Dated: December 26, 2024

First Attendee's Name

First Name*

Last Name*

Phone*
First Attendee's Age Acknowledgment*
First Attendee's Date of Birth*
I certify that I am 18 years of age or older
First Attendee's Signature*
Second Attendee's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Attendee's Date of Birth*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Zip Code

Zip Code: *
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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 Age Acknowledgment*
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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