Hold Harmless & COVID Form
Aug 28, 2026 11:49 PM
WAIVER – RELEASE – ASSUMPTION OF RISK FOR INJURY, INCLUDING COMMUNICABLE DISEASES
(COVID-19)
I agree not to attend any class, lesson, practice, performance, or other activity associated with Tina Stemmler and
Christina Stemmler with Tapping with Tina’s Ballerinas & Dance Teachers On Tour, as well as its directors, employees,
instructors, and other students if I am knowingly exposed to anyone diagnosed with COVID-19 or showing potentials
symptoms of COVID-19. I agree not to participate in any activity offered by Tina Stemmler and Christina Stemmler with
Tapping with Tina’s Ballerinas & Dance Teachers On Tour, as well as its directors, employees, instructors, and other
students if I am exhibiting symptoms of illness, and I understand that I am obligated to notify Tina Stemmler in the event
that I begin showing symptoms of illness related to COVID-19.
I understand and acknowledge that because of the physical nature of DANCE, there may be physical contact between
employees, staff, instructors and other students during classes, private lessons, rehearsals, shows, workshops,
productions, and dance instruction. I understand that at times, for proper instruction and safety, physical contact is
required and necessary.
I, on behalf of myself, my heirs, executors, agents, assigns, and representatives, hereby indemnify, release and forever
hold harmless Tina Stemmler and Christina Stemmler with Tapping with Tina’s Ballerinas & Dance Teachers On Tour, as
well as its directors, employees, instructors, and other students from any and all claims of liability arising from any
accident, personal injury, illness, death, or property loss or damage sustained while I am participating in (or due to my
participation in) activities connected with Tina Stemmler and Christina Stemmler with Tapping with Tina’s Ballerinas &
Dance Teachers On Tour, as well as its directors, employees, instructors, and other students. I understand that dance
activities have inherent risks of injury, and, partner/group dance activities have inherent risks of exposure to germs and
potential illnesses, including COVID-19, due to contact with other people and presence in spaces where people have
been. Being fully aware of all risks, I am choosing to participate in the classes, lessons, programs, and activities offered
by Tina Stemmler and Christina Stemmler with Tapping with Tina’s Ballerinas & Dance Teachers On Tour, as well as its
directors, employees, instructors, and other students, and I accept full responsibility for my own physical health and
wellbeing. By signing this statement, I declare that I am in good health, with no physical conditions or known illnesses
that might prevent my participation in dance activities and/or safe contact with those individuals participating with
me.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND
ITS TERMS, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Initial _____________
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained
the provisions in this waiver/release to my child, including the risks of presence and participation and his/her
personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.
Furthermore, my child understands and accepts these risks and responsibilities. I, for myself, my spouse, and child
do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child do
release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor
child’s presence or participation in these activities as provided above.
Name of participant/Dancer: ________________
_______________________________________
Name of parent/guardian: ____________________
____________________________ ___________________
Parent guardian/signature:______________________ ________________________________________________
Date signed: ___________________