Release and Waiver of Liability and Indemnity Agreement
(Read Carefully Before Signing)
I/we realize that participation in dance classes and activities could involve some possible personal injury.
Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the dancer and
parent/guardian) assume all risks related to the use of any and all spaces used by Shay Fierce Dance
Academy, LLC.
Release
By signing this document, I/we release and hold harmless Shay Fierce Dance Academy, LLC and their
directors, owners, students, teachers, staff, volunteers, associates (collectively referred to in this document
as “SFDA”) from any liability or claim that I or my representatives may have against SFDA with respect
to any bodily injury, personal injury, illness, or property loss or damage that may result from my
participation at SFDA. My participation at SFDA is entirely voluntary, and I choose to participate in spite
of the risks.
Dance education sometimes requires hands-on instruction as well as verbal instruction. Instructors may
correct dancers by touching their arms, legs, feet, hips, back and head to move them in the correct
position. I acknowledge that this is a common standard in dance instruction and understand that it is my
responsibility to communicate clearly with my teacher and/or the director if any form of touch is
unacceptable to me.
Medical Treatment and Insurance
I understand that SFDA does not assume any responsibility for or obligation to provide financial or other
assistance in the event of injury or illness, including but not limited to medical, health, or disability
insurance or support.
I authorize SFDA to obtain necessary medical treatment, including first aid, or such other care necessary
for my health and welfare in an emergency. If my insurance does not cover emergency treatment that is
deemed necessary and sought for me by SFDA, I agree to be responsible for and pay all costs incurred on
my behalf.
I understand that SFDA does not carry or maintain health, medical, dental, or disability insurance
coverage for any participant. I agree to take responsibility for full payment of any emergency medical
costs related to my SFDA participation regardless of whether I have insurance coverage.
Photographic Release
I understand that SFDA may take photo and video recordings of me during my participation in SFDA
classes and activities. I convey to SFDA full rights and interest in these recordings. I understand such
recordings may be used in advertising or other published materials, physical or virtual.
If I do NOT consent to being photographed or video recorded, I will make sure the director is aware of my
concerns and the reasons for them, I will be proactive about avoiding being photographed or recorded, and
I will hold SFDA harmless if a photo or video recording of me is released despite all precautions. I
understand that this choice may limit my participation in performances that are routinely photographed
and/or videotaped.
Miscellaneous
Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our
behavior in addition to any damage I/we may cause to the facilities utilized by Shay Fierce Dance
Academy, LLC.
I understand that Shay Fierce Dance Academy, LLC is a licensed and insured business. In the event that
I/we should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to
report the unsafe conduct or conditions to the Owner, Director, Instructor or Staff member as soon as
possible.
I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document
shall remain in full force and effect.
Signature
I/we certifying that I/we have read this document, understand it in its entirety, and agree to be bound by its
terms, before participating in classes.