2022-23 Waiver + Release Form

In consideration of the risk of injury while participating in dance (whether joining online classes or in-person) (henceforth referred to as the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for my child(ren), myself, their parents/guardians, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my or my child(ren)’s participation in the Activity, and do hereby release and forever discharge 5th Element Center for Dance, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I or my child(ren) may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

I OR MY CHILD(REN) IS VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND IS PARTICIPATING IN THE ACTIVITY ENTIRELY AT THEIR OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS’ NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY OR MY CHILD(REN)’S PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY. 

I agree to indemnify and hold harmless 5th Element Center for Dance against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my or my child(ren)’s behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my or my child(ren)’s behalf. If 5th Element Center for Dance incurs any of these types of expenses, I agree to reimburse.

I acknowledge that 5th Element Center for Dance and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of 5th Element Center for Dance.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER AND RELEASE” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE 5th Element Center for Dance AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST 5th Element Center for Dance FOR PERSONAL INJURY OR PROPERTY DAMAGE.

In the event that any damage to equipment or facilities occurs as a result of my, my child(ren)’s, or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant’s Parent/Guardian and 5th Element Center for Dance agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

5th Element Center for Dance has put in place preventative measures to reduce the spread of COVID-19; however, 5th Element Center for Dance cannot guarantee that you, your child(ren), or others in your household will not become infected with COVID-19. Further, attending 5th Element Center for Dance could increase your risk, your child(ren)’s risk, and the risk of those in your household contracting COVID-19.

By electronically signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), my household, and I may be exposed to or infected by COVID-19 by attending 5th Element Center for Dance programs and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at 5th Element Center for Dance may result from the actions, omissions, or negligence of myself and others, including, but not limited to, 5th Element Center for Dance employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at 5th Element Center for Dance or participation in programming (“Claims”). On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless 5th Element Center for Dance, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of 5th Element Center for Dance, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any 5th Element Center for Dance program.

BY REGISTERING AND PAYING FOR ANY CLASS, EVENT, PRIVATE LESSON, OR OTHER ACTIVITY THROUGH 5TH ELEMENT CENTER FOR DANCE, YOU ARE AGREEING TO ALL OF THE ABOVE CONDITIONS AND WAIVERS. PLEASE DO NOT HAVE YOUR CHILD/YOURSELF PARTICIPATE IN ANY CLASS OR EVENT UNLESS YOU ACCEPT AND AGREE TO ALL OF THE TERMS IN THIS AGREEMENT.

I have received and reviewed the waiver and release of liability terms: