RELEASE AND WAIVER OF LIABILITY
I , _______________________________, (student) understand that exercise and dance instruction and performance can be physically and mentally demanding as it requires strength, agility and concentration. I agree it is solely my responsibility to determine that I am in good health, both physical and mentally, and to involve myself in any of the activities offered, organized, run, sponsored or supervised by Lyra Dance Company, PLLC. I agree to consult with a licensed medical provider about my ability to participate in any activities offered, organized, run, sponsored or supervised by Lyra Dance Company, PLLC.
I also understand that certain risks are inherent to and from participation and involvement with Lyra Dance Company, PLLC and in its various formal and informal activities that could involve some personal injury or even death. I am voluntarily participating in Lyra Dance Company, PLLC’s activities, whether a class, workshop, rehearsal, program, competition or some other event offered, organized, run, sponsored or supervised by Lyra Dance Company, PLLC, and I am accepting the risk inherent in these activities, including the possibility of my being involved in an accident and suffering loss, injury and death, in the course of participating in these activities, whether they occur on the premises located at 349 Main St., Enosburg Falls Vermont, or at an offsite location, and whether they occur before, during or after these activities, including any transportation that is provided to any activities by Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents.
Accordingly, I hereby release and agree to indemnify and hold harmless Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents from any and all liabilities, cause of action, suits, claims and/or demands of any kind or nature, legal or financial, now or in the future, whether caused in any way by negligence or not, arising from the participation in or observation of any Lyra Dance Company, PLLC activity for injuries to person, including death, or property, whether on or off the premises located at 349 Main St. Enosburg Falls, Vermont. Furthermore, I agree that Lyra Dance Company, PLLC is not responsible for any lost or stolen property, at any time.
I agree that this release and waiver of liability is intended be as broad and inclusive as possible as permitted by Vermont law and that if any portion of this Release and Waiver of Liability is held to be invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect. I understand that this document is intended to limit my rights as well as the rights of my spouse as well as the rights of my legal representatives and heirs to bring suit against Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents.
I understand and acknowledge that should I be found to be violating any of the rules, codes of conduct, or found to be disruptive to either another individual or group, I may be asked to leave the premises or offsite location at any time and be refused reentrance without any full or partial refund.
I further agree to take full responsibility for my behavior including being responsible for the cost of any damage I may cause.
In the event that I should observe any unsafe conduct or conditions before, during or after the activities I am participating in, I agree to report the unsafe conduct or conditions to the Instructor as soon as possible.
In the event I am in an accident, injured or there is an emergency, I request and authorize Lyra Dance Company, PLLC to take me to a hospital or other medical facility for diagnosis and treatment. I hereby authorize Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents to act for the me according to their best judgment in providing or arranging for emergency care in any emergency circumstance requiring medical attention. I agree to hold old Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents harmless in the execution of this action. I further authorize physicians, dentists or other medical professionals to perform any diagnosis, treatment, including operative procedures that may be necessary.
I have read this Waiver and Release of Liability form and understand its contents and know that I have the right to review this document with counsel before signing.
I agree that no other statements, representations or inducements have been made to me that are not explicitly contained within this release.
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Student / Date
ACKNOWLEDGMENT OF
WAIVER AND RELEASE OF LIABILITY
BY PARENT/GUARDIAN/CUSTODIAN
I am the parent/guardian/custodian and certify I am legally authorized to act for _______________________, the student signing the attached Waiver and Release of Liabilty. I have read the attached Waiver and Release of Liability and I understand the content and the legal portent of the Waiver and Release of Liability and agree, both on my behalf and on behalf of the student, to be bound by its terms, to waive any and all claims as set forth in the Waiver and Release of Liability, and to release Lyra Dance Company, PLLC, its members, managers, instructors, employees and agents, as set forth in the Waiver and Release of Liability. I accordingly execute this acknowledgment and agree that the Waiver and Release of Liability is incorporated herein by reference and on behalf of the student and as parent/guardian/custodian of the student, I/we expect to be bound by its terms to the fullest extent possible.
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Parent/Custodian/Guardian(date)
