2018 Summer Baby Exploration
2 week Intensive
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Guardian Full Name: *
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Address *
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Phone *
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Student Full Name: *
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Student Birthdate *
Emergency Contact Name: *
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Emergency Contact Phone Number: *
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Does the student have any medical conditions? Explain *
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Choose the class(es) you are registering for. *
Liability Release Form (Please read before submitting form)
FDX Pure Sole LLC
Dance Studio
Liability Release Form

I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/ or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to FDX Pure Sole Dance Studio, it’s officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to as “FDX Pure Sole”.

I hereby agree to release FDX Pure Sole and hold FDX Pure Sole harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in dance on behalf of the participant.

I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.

I also give FDX Pure Sole permission to use my/my child’s picture and/or video in or on any form of advertisement for FDX Pure Sole or a FDX Pure Sole affiliated event.

I understand that FDX Pure Sole, LLC is a licensed, and insured organization. In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to the Director, Assistant Director, instructor or staff member as soon as possible.

If I am a minor, my parent and/or legal guardian has also signed this document releasing FDX Pure Sole from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.

The participant has my permission to participate in FDX Pure Sole Events.

I warrant the below information is complete and correct. I further release FDX Pure Sole of all liabilities associated with my child’s attendance at FDX Pure Sole.

Please submit this form and and return to the website to submit your registration fee. Your registration is not complete until your registration fee is received.
Thank you for registering with FDX Pure Sole!
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