I fully understand and acknowledge that there are risks and dangers associated with participation in dance events and activities which could result in bodily injury. These risks and dangers may be caused by my action, inaction or negligence, or the action, inaction or negligence of others. There may be other risks that are not known or that are not reasonably foreseeable at this time. I accept and assume all such risks and responsibility for any losses and/or damages following any injury, however caused and whether caused in whole or in part by the negligence of the Releasees named below. I acknowledge that Hamby Ballroom Dance Studios, LLC (herein after referred to as the STUDIO) will not render any medical services including medical diagnosis of any physical condition. I affirm that I am in good health and suffer no physical impairment that could limit my use of the facilities of the STUDIO. I HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Hamby Ballroom Dance Studios, LLC, as well as it’s owners, and any of the instructors at the STUDIO. I specifically agree that the STUDIO, its officers, members, employees, agents and legal representatives, whether acting in their business or individual capacities, and their successors and assigns (each a “Releasee” and collectively the “Releasees”) shall not be liable for any claim, demand, or cause of action of any kind whatsoever for, or on account of death, personal injury, property damage or loss of any kind resulting from or related to my use of the STUDIO’S facilities or my participation in any dancing, or exercise or activity within or without the studio premises, and I agree to hold the Releasees harmless for same.
I hereby affirm that I have read and fully understand these terms and intend my signature to be complete and unconditional release of all liability to the greatest extent allowed by law.
Signature_____________________________________________________________
Date_________________________________________________________________
Participant (print name)__________________________________________________
Please print this form, complete and sign it, and mail with your student registration form and check payable to:
Suzanne Hamby
18 Dartmouth Drive
Framingham, MA 01701