Request edit access
Liability + Safety Protocol
Sign in to Google to save your progress. Learn more
Email *
Please read through the Liability Waiver and Safety Protocol then sign and date below.
Waiver of Liability

I assert that any and all participation by me in physical activity at this movement/dance class, whether in sessions, in the exhibit halls, or elsewhere on the grounds, will be voluntary. In consideration for being allowed to participate in this movement/dance class, I, on behalf of myself, my spouse, my heirs, and my estate, hereby release, waive, indemnify, and save harmless Valerie Chafograck, any substitute teacher(s), BFUU and all BFUU employees, volunteers, or agents, from liability from any and all physical or other injuries or harm (including those resulting from the ordinary negligence of Valerie Chafograck, any substitute teacher(s), BFUU, its employees, volunteers, or agents) suffered by me during, or as a consequence of, participation in any and all physical activity associated with the movement/dance class.

I further understand that there are serious inherent risks involved with all physical activity and that when performing exercise routines or engaging in any similarly strenuous activity, I may suffer minor injury, serious injury, or even death. I understand these inherent risks, and I assume all such inherent risks associated with participation in any activities in conjunction with the Soul Motion movement/dance class and release Valerie Chafograck, any substitute teacher(s), BFUU, all employees, volunteers, or agents from liability. By agreeing with this document, I agree to these conditions.

Valerie Chafograck, any substitute teacher(s), BFUU are not responsible for acts of God or nature, terrorist attacks, war, union or labor disputes or other events out of its control.

Continuation of Agreement: I understand and agree that this release, to the maximum extent allowed by law, will have the effect of releasing, discharging, waiving, on my own behalf and on behalf of my minor children, survivors, assigns, heirs and estate and forever relinquishing any and all actions or causes of action that I may have or have had against Valerie Chafograck, any substitute teacher(s), BFUU whether under statutory or common law existing now or in the future, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my participation in activities while at Valerie Chafograck’s movement/dance class and BFUU facilities. I fully understand that I cannot hereafter make further claims or seek any further recovery of any nature whatsoever against Valerie Chafograck, any substitute teacher(s), BFUU, based upon, arising out of, or in connection with my participation in activities at Valerie Chafograck’s movement/dance class or use of BFUU facilities, and I hereby expressly waive all future unknown claims caused by, or alleged to be caused by, any act or omission by Valerie Chafograck, any substitute teacher(s), BFUU other than those arising from gross negligence.

Release of Owner: Each and every release, waiver and indemnification of Valerie Chafograck, any substitute teacher (s), BFUU provided in this agreement shall also apply, with equal force and effect, as a release, waiver and indemnification of the owner of the property in which the facilities of Valerie Chafograck’s classes are located.

California Civil Code Concerning Release of Liability for Unknown Claims and Liability for Ones Negligent Acts or Omissions: I am aware of and specifically waive the provisions of California Civil Code Section 1542, which provides as follows: " A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor." I am aware and specifically waive on my behalf and on behalf of the minor participant, as applicable, any claims which I did not know existed or did not suspect to exist in my favor or minor participant's favor, as applicable, at the time of executing this release, which if had been known to me would have materially affected me signing this Release of Valerie Chafograck’s, any substitute teacher(s), BFUU liability. I am aware of and specifically waive the provisions of California Civil Code Section 1714, which provides in pertinent part as follows: “Everyone is responsible, not only for the result of his or her willful acts, but also for an injury occasioned to another by his or her want of ordinary care or skill in the management of his or her property or person .

Governing Law, Jurisdiction and Severability of Provisions. This Waiver and Release of Liability shall be governed by California law and construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. In the event that I file a lawsuit against Valerie Chafograck, any substitute teacher(s), BFUU, I agree to do so solely in the state of California. I agree that if any portion of this Waiver and Release of Liability is held to be invalid, the rest shall nonetheless remain in full force and effect.





Safety Guidelines and Protocol --- Soul Motion® Lab & Movement Liberation

These guidelines have been created to support a safe, sacred space, and well-being for all participants.
1) We ask that you enter the dance hall with reverence and respect for the space and all humans. Please remember that Soul MotionTM is a conscious embodiment practice. Our body is our primary expression and wisdom of choice. The first commitment to safety and integrity is with our principle partner, the self.
2) This dance floor is free from talking (except as needed for safety), lifting each other off the floor, photos, videos, intoxicants, and scents. Please turn off mobile devices.
3) If you are feeling uncomfortable with the way that a dancer is engaging with you, it is your responsibility to set boundaries. Here are some suggested tools:

A. NONVERBAL BOUNDARY SETTING
There are various intentions and nuances for expressing boundaries nonverbally.
Part of our conscious dance practice is to pay attention to and respect nonverbal motions and facial/bodily gestures as complete expressions in and of themselves. Here are two examples…
If you are dancing with one or more people, and your intention is to dance solo, you may try moving away and avoiding eye contact.
If another person comes closer than you want, you may try extending your arms and/or legs to clearly define and carve out your comfortable personal space, avoiding eye contact, and not echoing the other person’s energy or motions.

B. VERBAL BOUNDARY SETTING
Speak your request to the person. Be audible, clear, and concise.
The verbal request must be IMMEDIATELY respected by the other person.
If your verbal request is not honored…

Find the Dance Ally (photo posted on the wall) to report this incident for further support.
The Dance Ally will listen to you and then the other person, one at a time, and then decide the next steps for greater understanding and mutual agreement by both parties to resume on the dance floor.
After resuming, the Dance Ally will maintain awareness of both dancers and check in with both parties at the end of class.

At this point, if needed, there can be further communication with Valerie.
It is our hope that this function will not be needed often. We, as a community, are responsible first and foremost to speak up with each other and to listen -- to build confidence, responsibility and trust amongst ourselves, and to only call on a Dance Ally when that level of support is truly necessary.

4) If a 2nd incident occurs (not necessarily with the same reporter), the Dance Ally will give a Mindfulness Request (MR) to the person. An MR is an opportunity for the person to be curious, self-reflective, gain insight, become aware of their impact, and to take steps to shift their behavior.
5) If a 3rd incident is reported to a Dance Ally after an MR has been made, the person will be asked to leave the dance immediately and not return until the Community Council* decides the best course of action. Actions may include mediation, some form of restorative justice, and/or suspension from class. Depending on the case, there may be additional guidelines or conditions for re-integration and re-entry.

*The Community Council includes Valerie and a diverse population of trusted members of the community who have experience with public service, and have been asked to serve by Valerie. The Council will advise and support Valerie, as well as make decisions as needed according to this protocol. The Council is also empowered to make recommendations and executive decisions regarding the wellbeing and safety of every body and all bodies on Soul Motion Lab dance floor. Council decisions will be made by seeking full consensus if possible, but consensus minus one or majority vote if needed. Decisions of the Council will be conveyed in writing to the directly involved parties.

May our movement echo, inspire, and be of service to all dance communities.


BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED DURING MY PARTICIPATION IN A MOVEMENT/DANCE CLASS ACTIVITY, I MAY BE FOUND BY A COURT OF LAW TO HAVE WAIVED MY RIGHT TO MAINTAIN A LAWSUIT AGAINST VALERIE CHAFOGRACK, ANY SUBSTITUTE TEACHER, BFUU ON THE BASIS OF ANY CLAIM FROM WHICH I HAVE RELEASED THEM HEREIN. IT IS THE INTENTION OF THE UNDERSIGNED TO EXEMPT AND RELIEVE VALERIE CHAFOGRACK AND ASSOCIATED PARTIES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND VALERIE CHAFOGRACK AND AFFILIATED PARTIES AND I SIGN IT OF MY OWN FREE WILL. I HAVE READ AND UNDERSTAND THE AGREEMENTS OF THE ATTACHED SAFETY
PROTOCOL, AND I ACCEPT AND AGREE TO ALL ITS TERMS AND CONDITIONS.

Full Name: *
Signature *
Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report