When renting at The Between Space Studio, this form will be presented to you to be filled out prior to using the studio:
*Form is subject to change. If form does change, you will be required to fill out updated form on your next visit.
THE BETWEEN SPACE STUDIO
WAIVER AND RELEASE OF LIABILITY FOR ALL CLASSES
I, ________________________________ HEREBY AGREE TO THE FOLLOWING:
I represent and warrant that I am physically fit and I have no medical conditions that would prevent me from my full participation in this class. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any physical activity.
In consideration of being permitted to participate in any fitness, yoga, dance class, I agree to assume full responsibility for any risks, injuries, accidents, damages, known or unknown, and or loss I may receive or sustain as a result of participating in the program, learning and/or practicing any technical movement during this activity I have agreed to participate in.
In consideration of being permitted to participate in any fitness, yoga, or dance class, I knowingly, voluntarily, and expressly waive any claim I have against The Between Space Dance Studio, landlord, all instructors, or property owner for injuries or damages that I may sustain as a result of participating inside or outside The Between Space Dance Studio property.
I, my heirs or legal representatives forever release, waive, discharge and covenant not to hold liable or sue The Between Space Dance Studio, landlord, instructors, owners, insurers, or any instructor for any injury or death caused by negligence or any other act.
Due to the nature of dance class, fitness class, yoga class, some touching and/or placement of proper body placement might be involved.
I herby consent for myself to be photographed or videotaped during any class, recital or rehearsal for the use of media publicity. I understand that no financial benefits from the use of the photography or video footage are obligated to be paid to me. I consent these photographs or video footage may be used for the purpose of promoting The Between Space Dance Studio and any the classes it wishes to promote.
I agree to this waiver and release of liability form for the duration of any and all classes I participate in from the date signed, until I legally terminate my participation in all specified classes held at the Between Space Studio.
I have read and understand the policies, rules and regulations in regards to The Between Space Dance Studio that is clearly posted on The Between Space Dance Studio’s web site.
I have read the above release and waiver of liability form and I fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Name (Please Print): ___________________________________ Birthdate: _____________
In case of emergency, contact: ___________________________ Phone: ________________
Participants Signature: _________________________________ Date: __________________EMAIL ADDRESS: ____________________________________________________
Participant’s Signature (if under 18 years of age)
I represent that I have the legal capacity and authorize to act on behalf of the minor named herein.
Name of Minor: _______________________________________________________ Parent/Guardian Signature: ______________________________________________