1. I am participating in ZUMBA© classes at Congregation Beth Sholom, 301 14th Ave San Francisco, CA, offered by ZUMBA© FITNESS WITH TAI/Taina Lipinski (formerly Batista). I recognize that ZUMBA© FITNESS requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.2. In consideration of being permitted to participate in ZUMBA© Classes, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.3. In further consideration of being permitted to participate in ZUMBA© Classes, I knowingly, voluntarily and expressly waive any claim I may have against the owners, instructors, and assistants, individually or otherwise, by ZUMBA© FITNESS WITH TAI/Taina Lipinski (formerly Batista) and the Congregation Beth Sholom for damages, and injury, including death, that I may sustain as a result of participating in ZUMBA© classes.4.I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,5. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Instructor immediately; and,I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS ZUMBA© FITNESS WITH TAI/Taina Lipinski (formerly Batista) and The Congregation Beth Sholom their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
￼Signature ___________________________ Date_____________________