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I have chosen to participate, or have chosen for minors within my care to participate (referred to hereafter as PARTICIPANTS), in dance instruction provided by Stacey Lund d/b/a Yucaipa Dance, it's employees and independent contractors (referred to hereafter as YUCAIPA DANCE).

I acknowledge and understand the nature of the environment and activities that all PARTICIPANTS will be participating in and I have determined that all PARTICIPANTS are in the proper physical health and condition to be safe and capable of participating in the related activities without becoming a danger to themselves or to anyone else around them in the shared environment.

I understand that YUCAIPA DANCE is not in any way responsible for making such a determination.

In consideration of all PARTICIPANTS enrollment in any dance instruction program offered by YUCAIPA DANCE, I understand and agree on behalf of all PARTICIPANTS to release, hold harmless, and discharge YUCAIPA DANCE from all claims, costs, liabilities, expenses or judgments, including attorneys' fees and court costs for any occurrences in connection with any activities or instruction provided by YUCAIPA DANCE.

I assume responsibility for all risks to PARTICIPANTS in connection with any instruction and further release YUCAIPA DANCE from all liability for any injury sustained by PARTICIPANTS while enrolled in any dance instruction program. This includes, but is not limited to, physical injury sustained from physical activity, as well as all illnesses (such as COVID-19) that may possibly be contracted through contact with any part of the environment in and around the building where YUCAIPA DANCE provides dance instruction.

I understand and acknowledge that while YUCAIPA DANCE will endeavor to make the environment for dance instruction as clean and as safe as is reasonably possible, I the undersigned am ultimately and completely responsible for the health and safety of all PARTICIPANTS as well as any other persons traveling with me.

I further understand that YUCAIPA DANCE is not responsible for any and all lost, damaged, broken, missing or stolen personal property belonging to PARTICIPANTS as well as any other persons that may be traveling with me.

I acknowledge and agree that it is my responsibility to maintain my own accident and health insurance coverage that provides adequate coverage for PARTICIPANTS and that YUCAIPA DANCE does not provide accident or health insurance for any PARTICIPANTS in any provided instruction or activities.

I authorize YUCAIPA DANCE to take and use photographs, videos or likenesses of PARTICIPANTS as needed for its record-keeping, advertising and public relations projects and I release all rights I may hold to the same and will not be compensated for the same.

My signature below is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.

I AGREE THAT I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO AGREEMENT.