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2021/22 JUMPSTART COMPANY Audition (5-9)

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Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)*

Students entered below will be added to your family's account

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Where have you studied dance?*
How long have you studied each genre: Ballet, Jazz, Contemporary, Hip Hop, Tap?*

Additional Information:

COVID 19 Waiver

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Assumption of the Risk and Waiver of Liability Relating to
Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the
World Health Organization. COVID-19 is extremely contagious and is believed to
spread mainly from person-to-person contact. As a result, federal, state, and local
governments and federal and state health agencies recommend social distancing and
have, in many locations, prohibited the congregation of groups of people.
THE INDUSTRY Dance Academy LLC has put in place preventative measures to reduce the spread of
COVID-19; however, cannot guarantee that you or your child(ren) will not become
infected with COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and
voluntarily assume the risk that my child(ren) and I may be exposed to or infected by
COVID-19 by attending THE INDUSTRY Dance Academy LLC and that such exposure or infection may
result in personal injury, illness, permanent disability, and death. I understand that the
risk of becoming exposed to or infected by COVID-19 at THE INDUSTRY Dance Academy LLC may
result from the actions, omissions, or negligence of myself and others, including, but not
limited to THE INDUSTRY Dance Academy LLC employees, volunteers, and program participants and
their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for
any injury to my child(ren) or myself (including, but not limited to, personal injury,
disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that
I or my child(ren) may experience or incur in connection with my child(ren)'s attendance
or participation in THE INDUSTRY Dance Academy LLC's programs ("Claims"). On my behalf, and on
behalf of my children, I hereby release, covenant not to sue, discharge, and hold
harmless THE INDUSTRY Dance Academy LLC, its employees, agents, and representatives, of and
from the Claims, including all liabilities, claims, actions, damages, costs or expenses of
any kind arising out of or relating thereto. I understand and agree that this release
includes any Claims based on the actions, omissions, or negligence of THE INDUSTRY Dance Academy LLC, its employees, agents, and representatives, whether a COVID-19
infection occurs before, during, or after participation in any THE INDUSTRY Dance Academy LLC programs or events.

I've read the above and agree.

Liability Waiver

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STUDENT LIABILITY WAIVER

The following is hereby agreed upon. In consideration of being allowed to participate as a student in any way in one or more dance or exercise programs, its related events and activities (such workshops, events, and activities are collectively referred to herein as the "Program"), I, the parent of the referenced Dance Student in this registration, acknowledge, appreciate, and agree that:
1. I am an adult over 18 years of age (or, if a child under 18 - see below), and understand the inherent risks, typical hazards, and potential consequences associated with dance or exercise; and
2. The risk of injury from the activities involved in the Program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and
3. I further understand that some of those risks include, but are not limited to, incidents which may cause one to fall and that THE INDUSTRY may not have any control over such events. I also understand that injuries may be caused by my own behavior, conduct, or lack of skill; and
4. I fully understand and am knowledgeable of these risks and hazards of dance courses. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS , both known and unknown, EVEN IF ARISING FROM THE NEGLEGENCE of others, and assume full responsibility for my participation; and
5. I willingly agree to comply with the stated and customary terms and conditions for participation in the Program. If, however I observe any unusual significant hazard during my presence or participation I will remove myself from participation and bring the hazard to the attention of the nearest official THE INDUSTRY Management team member immediately; and
6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE INDUSTRY, Maia and Richard Suckle, Suckle Trust, Rhonda and Terry Notary, and its officers, officials, agents, employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Program, WIT H RES PECT TO ANY AND ALL INJURY, DISIBILITY, DEAT H, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF MYSELF OR THE ABOVE CORPORAT ION, INDIV IDUALS , OR PARTIES , to the fullest extent permitted by law.
7. I AM INFORMED AND AM AWARE OF ALL THE TYPICAL DANCE COURSE HAZARDS AND ASSOCIATED RISKS AND WISH TO OBTAIN IN DANCE INSTRUCTION FROM THE INDUSTRY Dance Academy (OR MY CHILD, IF APPLICABLE) DESPITE THESE HAZARDS AND RISKS. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
PARENT OR GUARDIAN CONSENT & APPROVAL: I am the parent or legal guardian of the above Dance Student under age 18. I have read and approved of all the foregoing and agree to bind myself, my spouse (if any) and the above referenced child to the terms of this liability waiver. My checked box and registration shall be considered to be an acknowledgement of my signing this liability waiver agreement in my own capacity and in my capacity as parent or legal guardian of the Dance Student. I also agree the THE INDUSTRY should not be responsible for the safety and well being of Dance Students who leave THE INDUSTRY's premises before, during, or after their scheduled class period(s). The parent or legal guardian understands and agreed THE INDUSTRY is not a day care center.

I've read the above and agree.

Payment Agreement / Policies

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Photography / Video Waiver

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