AFTER SCHOOL PROGRAM

LIABILITY WAIVER

Liability Waiver

46 Proton St N Southgate, N0C1B0 Phone: (416) 389- 8585 Email:jazznpizazzdancestudio@gmail.com Web: https://www.jazznpizazz.com LIABILITY RELEASE/WAIVER FORM All participants MUST complete this form. All participants and students must complete this form before participating in any classes/camps at Jazz 'n' Pizazz. If participant is under age 18, a parent or guardian must also sign this form. Admission to class/camp and/or rehearsal will not be granted if this form is not received prior to class and is not properly signed. Waiver of Liability. I/We recognize and understand the risks of physical injury inherent to dance and dance training as well as other activities taking place within camps and I fully assume those risks. I hereby release Jazz 'n' Pizazz, event sponsors, employees, facilitators and dance teachers from all liability for injuries sustained or illnesses contracted while attending or participating in any dance classes, rehearsals, workshops, camps or performances. I agree to indemnify, defend, and hold harmless Jazz 'n' Pizazz employees and dance teachers/facilitators for liabilities, costs and judgments arising from acts of omissions committed by me or my child which result in injury or damage to any person or property.

Parent Info

First Name

Last Name

Phone

(###)

###

####

Emergency Contact Information

Child Info

First Name

Last Name

Age

Medical Conditions or Allergies

Protection of Property

Attending or participating in any classes, rehearsals, workshops, or performances, Birthday Parties, Summer camps. I hereby release Jazz 'n' Pizazz Dance Studio, its affiliate dance studios, event sponsors, employees and dance teachers from all liability for loss or damage to my personal property while attending or participating in classes, rehearsals, workshops, or performances. I also agree to abide by any rules, regulations and policies set forth by Jazz 'n' Pizazz Dance Studio. Initial/Sign below Acknowledging this section

Medical Attention

In case of physical injury or medical emergency, I hereby authorize Jazz 'n' Pizazz Dance Studio to make necessary arrangements to transport myself or my child to a medical treatment facility as necessary. All such transportation and medical treatment will be at my sole cost and expense. In extreme emergency, or if my child is under 18 years of age, I understand that Jazz 'n' Pizazz Dance Studio will attempt to notify the person(s) I have named above as my emergency contact(s) of the condition and how to reach me. Initial/Sign Below Acknowledging this section

Photo Release

Jazz 'n' Pizazz Dance Studio reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting Jazz 'n' Pizazz Dance Studio and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify Jazz 'n' Pizazz Dance Studio prior to participation in class Jazz 'n' Pizazz Dance Studio reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting Jazz 'n' Pizazz Dance Studio and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify Jazz 'n' Pizazz Dance Studio prior to participation in class. Initial/Sign Below Acknowledging this section

Acknowledgement of Waiver

In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and am fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my or my child’s participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me or my child. Initial/Sign Below Acknowledging this section

Date

YYYY

Signature/E Signature

Parents Name

First Name

Last Name

Parents Phone

(###)

###

####

Students Name

First Name

Last Name

Age

First Name

Last Name

Medical Conditions

School

Pick Up

Walker

Yes

Dinner Add On

No, Thank you

Yes

Pick Up Name

First Name

Last Name

Pick Up Name

First Name

Last Name

Important Information You Want Me To Know ..........................( specific dates, times, notes )

AFTER SCHOOL PROGRAM

LIABILITY WAIVER

contact us

Location

Hours

Contact