REPRESENTATION AND WAIVER
I am not aware of any medical condition I have or am suffering from that should preclude me from participating in dance activities. I understand there is a definitive risk of injury associated with dancing and that such injuries include, but are not limited to bruises, dislocations, broken bones, torn or damaged muscles and ligaments, paralysis, and even death. I understand that such injuries may be caused in whole or in partly by myself, or by the actions or inactions of other students or instructors. I also agree to carefully follow the instructors’ directions, to ask for additional directions if I do not understand any particular activity, and to immediately stop any activity which I believe I am not competent or confident enough to perform.
I understand that in connection with the COVID-19 pandemic, Center for American Dance Inc. d/b/a Joffrey Ballet School is requiring all individuals who enter onto Joffrey premises, take a class at a Joffrey location or via remote learning, or otherwise participate in any Joffrey event to execute this Waiver and Release of Liability, acknowledging the risks related to COVID-19 as well as such other injuries that may result from such activities.
The waiver, release and other representations and covenants set forth herein are given in consideration for Joffrey permitting me and/or my child or ward to enter onto Joffrey premises, take a class at a Joffrey location or via remote learning, or otherwise participate in any Joffrey event.
Acceptance of Risk; Release; Indemnification. I am fully aware that there are a number of risks associated with me and/or my child or ward entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event during the COVID-19 pandemic or at any time, including without limitation: (a) I and/or my child or ward and/or our family and/or other third parties with whom we may come into contact could contract COVID-19 or other diseases (including but not limited to influenza [“the flu”] or legionnaires disease), which could result in a serious medical condition and/or require medical treatment in a hospital, and which may result in permanent harm and/or possibly lead to death; and (b) I and/or my child or ward will be subject to normal risks associated with engaging in physical activity such as physical injuries, including without limitation, from slips or falls, muscle pulls, broken bones, or such other serious injury, or loss or damage to personal property, or even death. On behalf of myself and/or my child or ward and our heirs, successors and assigns, I knowingly and freely, assume all such risks, both known and unknown (including but not limited to contracting COVID-19), relating to my and/or my child’s or ward’s entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event, and I hereby now and forever release, waive, relinquish, and discharge Joffrey, along with their officers, directors, shareholders/owners, managers, officials, trustees, agents, employees, Greenwich Village Ballet LLC and the employees of Greenwich Village Ballet LLC, or other representatives, and their successors and assigns (collectively, the “Joffrey Parties”), from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, (collectively, “Damages”) as a result of me and/or my child or ward entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event, including but not limited to those related to the above described personal injuries, death, disease or property losses, or any other loss, and including but not limited to claims based on the alleged negligence of any of the Joffrey Parties or any other person. I further promise not to sue or Joffrey or any of the Joffrey Parties, and agree to indemnify and hold them harmless from any and all Damages resulting from my and/or my child’s or ward’s entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event. I understand that my agreement herein is on-going and continuous and shall not need to be renewed, but Joffrey may request my updated signature at any time.
I further agree and request for myself and/or my minor children that our relevant health information regarding personal health information, care and treatment be released for the limited purpose of contact tracing related to the novel coronavirus COVID-19 pandemic. In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: (1) The information disclosed shall be limited only to information relevant to the COVID-19 pandemic and for the purpose of contact tracing; (2) This authorization shall NOT include disclosure of information relating to alcohol and drug abuse, mental health treatment, or confidential HIV related information. If this information is disclosed, I understand that I have the right to request a list of people who may receive or use the disclosed information without authorization; if I experience discrimination because of the release or disclosure of such information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450, which are the agencies responsible for protecting my rights; (3) I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization; (4) I understand that signing this authorization is voluntary and health care treatment, payment of health care charges, enrollment in a health plan, or eligibility for health care benefits will not be conditioned upon my authorization of this disclosure; (5) Information disclosed under this authorization might be redisclosed by the recipient, and this redisclosure may no longer be protected by federal or state law; (6) THIS AUTHORIZATION DOES NOT AUTHORIZE DISCLOSURE OF HEALTH INFORMATION OR MEDICALCARE WITH ANYONE OTHER THAN CONTACT TRACERS AND ONLY TO THE LIMITED EXTENT NEEDED FOR SUCH PURPOSE.
I understand that should I be diagnosed with COVID-19 I must immediately withdraw from the program, notify the Joffrey program and housing staff, and understand that , in accordance with the refund policy of the Center for American Dance (d.b.a. Joffrey Ballet School), I may not be eligible for a refund.
I have fully read and agree to all of the above, and I make this agreement and the representations herein in order to induce the Center for American Dance (d.b.a. Joffrey Ballet School), to accept me as a student for dance instruction.
In the event that the participant/student is a minor or is not of such capacity to be held legally responsible for executing this agreement, the undersigned parent and/or legal guardian signs this on behalf of the participant/student and individually. If, despite this release, the participant makes a claim against any of the Releases, the parent(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.
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Limited Use Photographic and Video Release
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For and in consideration of my engagement as a student/model by the Joffrey Ballet School – Center for American Dance (hereafter referred to as the School) and Joffrey Ballet School (hereafter referred to as the Photographer), on terms hereinafter stated, I hereby give the Photographer and the School, their legal representatives and assigns, those for whom the Photographer and School are acting, and those acting with their permission, the right to copyright and / or use, reuse and / or publish, and republish the photographic pictures and/or video of me taken during the course of my study at the School or at any School performances.
I hereby waive any right to inspect or approve the finished photograph(s) and/or videos prior to publication.
I hereby release, discharge and agree to save harmless the Photographer and the School, their representatives, assigns, or any other person or persons, corporation or corporations, for whom they might be acting, including any firm publishing or producing and / or distributing the finished product, in whole or in part, from and against any liability as a result of it’s publication or distribution of the same.
I certify that I, suffering under no legal disabilities and that I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof.
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Parental Authorization
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The Center for American Dance / Joffrey Ballet School is not liable or responsible for the negligence or for the acts of others. Students, parents/legal guardians of minor students and any other person or entity covered by this Agreement hereby agrees that The Center for American Dance / Joffrey Ballet School should not be liable for the act of any other person, including but not limited to any roommate, invitee, friend or neighbor of the dormitory residents or The Center for American Dance / Joffrey Ballet School staff or resident advisor. Student, parents of minor students and/or legal guardian, as well as any other person or entity signing this Agreement, agrees that The Center for American Dance / Joffrey Ballet School shall not, and cannot, be held liable for any negligence or acts of these others, including but not limited to any negligence in the placement of the student with a particular host or residence or roommate.
This Agreement shall be interpreted in accordance with the Laws of the State of New York. The Student/parents/guardians of a minor student, or any other entity or person signing this Agreement, hereby agrees to submit to the personal jurisdiction of the State of New York Center for American Dance / Joffrey Ballet School. Any litigation between the parties to this Agreement, for any reason or cause, including the alleged breach of this Agreement or otherwise, shall only be brought in the Supreme Court State of New York, New York County.