THE MOVEMENT DANCE STUDIO
LIABILITY WAIVER AND RELEASE OF CLAIMS
Participant Information
Participant Name: ______________________________________ Date of Birth: _________________________________________
Phone Number: _________________________________________ Email Address: ________________________________________
If Participant is under 18 years of age:
Parent/Guardian Name: _________________________________ Parent/Guardian Phone Number: __________________________
ASSUMPTION OF RISK
I understand that participation in dance classes, rehearsals, workshops, performances, and related activities at The Movement
Dance Studio (“the Studio”) involves inherent risks, including but not limited to muscle strains, sprains, falls, collisions, cuts,
bruises, overuse injuries, or other physical injuries. I acknowledge that these risks may result from my own actions, the actions of
others, or the condition of the facilities or equipment.
I voluntarily choose to participate and assume full responsibility for all risks of injury, illness, or damage, whether known or
unknown, that may occur as a result of my participation.
RELEASE AND WAIVER OF LIABILITY
In consideration for being allowed to participate in activities at The Movement Dance Studio, I hereby release, waive, discharge,
and covenant not to sue Movement Dance Studio, its owners, directors, instructors, employees, contractors, volunteers, agents,
and affiliates from any and all claims, demands, causes of action, or liability of any kind arising out of or related to my
participation, including but not limited to claims for personal injury, illness, property damage, or wrongful death, except where
caused by gross negligence or willful misconduct, to the extent allowed by law.
MEDICAL ACKNOWLEDGMENT
I confirm that I am physically able to participate in dance activities and have no medical conditions that would prevent safe
participation, or I have disclosed such conditions to the Studio in writing. I understand that the Studio does not provide medical
care.
In the event of an emergency, I authorize The Movement Dance Studio to seek medical treatment on my behalf if I am unable to
do so, and I agree to be financially responsible for any medical expenses incurred.
PHOTO AND VIDEO RELEASE
I grant permission to The Movement Dance Studio to photograph or record me during classes, rehearsals, or performances and
to use such images or recordings for promotional, educational, or marketing purposes (including social media and website),
without compensation.
☐ Initial here to agree: __________ ☐ Initial here to decline: __________
RULES AND CONDUCT
I agree to follow all studio rules, safety guidelines, and instructor directions. I understand that failure to comply may result in
removal from class or dismissal from the Studio without refund.
GOVERNING LAW
This agreement shall be governed by and construed in accordance with the laws of the state/province in which The Movement
Dance Studio operates.
ACKNOWLEDGMENT AND SIGNATURE
I have read this Liability Waiver and Release of Claims in its entirety. I understand its contents and sign it voluntarily, intending to
be legally bound.
Participant Signature: _______________________________ Date: ______________________________________________
If participant is under 18 years of age:
Parent/Guardian Signature: ___________________________ Printed Name: ______________________________________
Date: ______________________________________________