PLEASE READ THIS FORM CAREFULLY. BE AWARE IN REGISTERING YOURSELF OR YOUR MINOR CHILD/WARD FOR PARTICIPATION IN, OR YOUR PARTICIPATION IN, ANY DANCE OR FITNESS CLASS INCLUDING BUT NOT LIMITED TO TAP, KINDER TAP & MOVE, JAZZ, HIP HOP, SHOW JAZZ, IRISH, COMP TEAM, BALLET, POINTE, ACTING, MODERN, CHARACTER, EXERCISE WITH AND WITHOUT RESISTIVE TUBING OR WEIGHTS, ACROBATICS, BREAK DANCING, TECH, TREADMILL USE, MINI-TRAMPOLINE, STRETCHING, AND PRIVATE LESSONS THAT YOU WILL BE WAIVING AND RELEASING ALL CLAIMS FOR INJURIES YOU OR YOUR MINOR CHILD/WARD MIGHT SUSTAIN ARISING FROM PARTICIPATING IN ANY OF THE AFOREMENTIONED ACTIVITIES.
CHRISTINE RICH STUDIO ~ RETROGRACE SYSTEMS, INC.
WAIVER AND RELEASE OF ALL CLAIMS AND PERMISSION TO SECURE TREATMENT
I recognize and acknowledge that there are certain risks of physical injury to participants in classes including but not limited to Tap, Kinder Tap & Move, Jazz, Hip Hop, Show Jazz, Irish, Comp Team, Ballet, Pointe, Acting, Modern, Character, Exercise with and without resistive tubing or weights, Acrobatics, Break Dancing, Tech, Treadmill use, Mini-Trampoline, Stretching, and Private lessons, and I agree to assume full risk of injuries, damages, or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all said aforementioned activities.
By my signature below, I certify that I and/or my minor child are physically able to participate in classes and do hereby agree that this business, owners, employers, contractors, assistants or agents are not responsible or liable to me for any injury, accident, or loss of personal property. I do hereby release this business and its employees, contractors, assistants, owners and agents from any claim or cause of action which may have occurred as a result of participation in classes or as a result of any medical problem known or unknown which I have knowledge presently or in the future. I agree to waive and relinquish all claims I or my minor child/ward may have against Christine Rich Studio and its owners, agents, employees, contractors, instructors, and assistants as a result of participating in classes including but not limited to Tap, Kinder Tap & Move, Jazz, Hip Hop, Show Jazz, Irish, Comp Team, Ballet, Pointe, Acting, Modern, Character, Exercise with and without resistive tubing or weights, Acrobatics, Break Dancing, Tech, Treadmill use, Mini-Trampoline, Stretching, and Private lessons.
I further agree to indemnify and hold harmless and defend Christine Rich Studio, and its owners, agents, employees, contractors, instructors, and assistants from any and all claims resulting from injuries, damages and losses sustained by me or my minor child/ward arising out of, connected with, or in any way associated with classes including but not limited to Tap, Kinder Tap & Move, Jazz, Hip Hop, Show Jazz, Irish, Comp Team, Ballet, Pointe, Acting, Modern, Character, Exercise with and without resistive tubing or weights, Acrobatics, Break Dancing, Tech, Treadmill use, Mini-Trampoline, Stretching, and Private lessons.
In the event of an emergency, I authorize Christine Rich Studio or its agents to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for me or my minor child/ward's immediate care and agree that I will be responsible for payment of all hospital and medical charges which are incurred. I recognize and acknowledge that Christine Rich Studio or its agents will not be responsible for honoring specific hospital or healthcare provider preferences.
I hereby give the Christine Rich Studio AND Retrograce Systems Inc. the absolute right and permission to use my and/or my minor child's name, image, interview, performance or other auditory or visual image as a Christine Rich Studio or Recital participant and copyright and/or publish, or use pictures, or videotape footage, of me and/or my minor child of which the inclusion is in whole or in part, distributed through any lawful media, CRS Recital DVD, or Internet website owned by Christine Rich, Christine Rich Studio, or Retrograce Systems, Inc., including the Christine Rich Studio's Facebook, You Tube Channel or Google+, or other CRS social media pages such as Instagram or SnapChat, for research, education, advertising, promotion, trade, merchandise or any other lawful purpose whatsoever whether taken in the classroom, prior to, or after class, at a Studio event, or a dance performance, dress rehearsal, or dance recital, and whether these specific events are within, pre, or post the enrolled semester. I hereby waive any right that I may have to inspect and/or approve the finished product that may be used in connection therewith, or the use to which it may be applied.
I have read and fully understand the above Waiver and Release of All Claims and Permission to Secure Treatment.
As a condition of the Student's enrollment, the Student and family members and/or guests shall abide by the Christine Rich Studio Policies and the On Time Policy: Student Arrival and Pick-Up Agreement. The undersigned acknowledges receipt of a copy of the Christine Rich Studio Policies (online at www.ChristineRichStudio.com or at Studio) and will share this information and waiver with other family members.