Release/Waiver
I am the parent/guardian of this student and hereby request that he/she be permitted to engage in Irish Dance class, utilizing facilities owned, operated and/or maintained by The Galleria Mall of Mt Lebanon, Pittsburgh, PA. I expressly acknowledge and recognize that participation in said dance activities creates a rise of injury to person or property and hereby expressly release, remise and forever discharge the class instructors and their assigns, The Galleria Mall of Mt Lebanon, Pittsburgh, PA and its officers, agents and employees from any liability for any and all claims, suits or causes of action arising from injuries to the person or property of the student named above as a result of his/her use of recreational facilities owned, operated and/or maintained by The Galleria Mall of Mt Lebanon, Pittsburgh, PA.
My submission of this registration confirms that this student does not have any pre-existing medical condition that would prohibit or limit their full participation in his/her class curriculum. Should my child/this student have a pre-existing medical condition that would limit or prohibit his/her full participation in his/her class curriculum, I will provide written medical clearance from his/her primary care physician prior to admittance as a student of the Shovlin Academy of Irish Dance.
I have read this release and intend to be legally bound by submission of this registration.
