ADULT WAIVER FORM | Island Groove

WAIVER AND RELEASE OF LIABILITY

I understand the nature of the dance & fitness activities that I will be participating in during classes & events at Island Groove Dance Studio.

Insurance/Waiver: Island Groove Dance Studio (IGD) does not carry medical insurance for its participants. It is required that all participants be covered by their own insurance policy. If injury or illness does occur, it is understood that the participants/student's own policy is the only source for reimbursement.

2024-2025 WAIVER AND RELEASE OF LIABILITY AND CONSENT TO EMERGENCY MEDICAL TREATMENT

Assumption of Risk I, the undersigned parent or guardian of the below-named minor child (the “Participant”), who desires to participate in dance classes and performances offered and organized by Island Groove Dance Studio (the “Studio”), hereby acknowledge that I am aware that there are significant risks associated with participation in such dance classes and performances, including, without limitation, the risk of serious bodily injury or death. On behalf of myself, my spouse and Participant, and our respective heirs, administrators, representatives and successors, I willingly assume such risks.

Further, I hereby represent that Participant has no physical or mental disability or impairment or any illness that will endanger Participant or others in connection with Participant’s participation in the dance classes and performances offered by the Studio. Waiver and Release I, the undersigned parent or guardian of the Participant, for myself, my spouse and Participant and our respective heirs, administrators, representatives and successors, hereby waive the right to bring any claim or suit and hereby voluntarily release and discharge the Studio, its owner (Renee Scarpelli), employees, independent contractors, agents and insurers from any and all claims, demands, causes of action, liabilities, damages, costs or expenses (referred to herein collectively as “Claims or Losses”) arising out of, relating to or in any way connected with Participant’s participation in the Studio’s dance classes and performances, including, without limitation, any Claims or Losses for personal injury, wrongful death or property damage allegedly arising out of the negligent acts or omissions of the Studio’s owner(s), employees, independent contractors or other agents.

Use of Photography: It is understood the Island Groove Dance Studio (IGD) reserves the right to use any photography and videotaping of a student’s performance or classes for purposes of advertising, promoting or publicizing the studio. All ownership, including copyright, shall belong to Island Groove Dance Studio.

First Name

Last Name

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Your name and signature

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

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