Dance Works Event Participation Waiver Form
This form MUST be completed by the Parent/Guardian of each guest before entering DANCE WORKS studio.

I, the undersigned, represent, acknowledge and accept the participation in the activities for which the Participant is registered includes strenuous physical activity and involves foreseeable risks of serious injury (including paralysis and even death) with or without the negligence of others. Participant, on his or her behalf, and the parent/guardian, on behalf of Minor Participant as well as on their own behalf, unequivocally agree to incur and assume such risk as a condition to participation in the activities for which Participant is registered.

As consideration for being permitted by Emma Mead and/or Dance Works LLC, the State of Virginia, the City of Newport News, and any lessor of Emma Mead and/or Dance Works LLC premises (“Suite #108, Fishing Point Center, DF Fishing Point and or DruckerandFalk”), to participate in these activities and use the Emma Mead and/or Dance Works premises and facilities, I forever release Emma Mead and/or Dance Works LLC, the State, the City, the Lessor, any fair affiliated organization, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from any and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in these activities, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Releasee, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release.
I also give Emma Mead and/or Dance Works permission to use my picture or child’s picture in any letter, web page, flyer, etc.
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 THE FAIR, THE STATE, THE CITY, AND THE LESSOR, AND SIGN IT OF MY OWN FREE WILL.
If Signed by Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them.

Name of Participant *
Your answer
Age of Participant *
Your answer
Name of Parent/Guardian filling out form *
Your answer
Cell Number of Parent/Guardian
Your answer
Email address of Parent/Guardian *
Your answer
By selecting the "yes" option, I agree to the statements above and understand its contents. I am aware that this is a release of liability and a contract between myself and the fair, the state, the city, and the lessor, and sign it of my own free will. *
Date of completion *
MM
/
DD
/
YYYY
I verify that this form was completed by the Parent/Guardian named above. (Please enter complete name below) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service