RELEASE OF LIABILITY, WAIVER OF LIABILITY,
ASSUMPTION OF FULL RESPONSIBILITIES FOR ALL RISKS OF
BODILY INJURY, DEATH OR DAMAGES

As parent or legal guardian of _________________________________________, I give my consent for (please circle) her / him / them / myself to participate in the programs at Perrysburg Dance Academy LLC.  I understand it is the express intent of Perrysburg Dance Academy LLC to provide for the safety and protection of my child(ren). I understand that participation in dance, acrobatic dance, parades, performances, and related activities may result in injuries due to heights, motions and movements involved. These injuries may include muscle strains and tears, broken bones, and severe injuries, such as permanent paralysis or even death.

 

As parent or legal guardian, I agree to provide health insurance for the minor child(ren) or guarantee payment of any medical expenses incurred as a result of training, performing, or participating in activities of Perrysburg Dance Academy LLC.

 

As an adult, I agree to provide health insurance for myself or guarantee payment of any medical expenses incurred as a result of training, performing, or participating in activities of Perrysburg Dance Academy LLC.

 

As an adult, I give permission for Perrysburg Dance Academy LLC to use my or my child(ren)’s photo or likeness in any form of publicity.

In consideration of the use of facilities of Perrysburg Dance Academy LLC I waive all rights or causes of actions against the building owners, and/or Perrysburg Dance Academy LLC for injuries or other damages suffered by my child(ren) and/or myself while under the supervision of Perrysburg Dance Academy LLC and its employees.

It is also my intent to release Perrysburg Dance Academy LLC and its employees from any liability in the future.

This ACKNOWLEDGEMENT OF RISK and WAIVER OF LIABILITY has been read by me, understood completely, and signed voluntarily. I am eighteen (18) years of age or older.

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Parent/Guardian Signature                                                                 Date      

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