Name *

First Name

Last Name

Phone *

(###)

###

####

Which class are you taking? *

Beg Jazz

Int Tap

Fitness

Beg Ballet

Int Jazz/Contemporary

Which Location: *

Smithfield

Coventry

Physical readiness to participate: *

I have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my or my child's participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity *

I Understand & agree

Assumption of Risk: *

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I or my child is physically fit, have sufficiently prepared or trained for participation *

I understand & Agree

Release & Discharge: *

I HEREBY WAIVE, RELEASE, AND DISCHARGE To The Pointe of Performing Arts Inc., and all divisions thereof of any and all liability and responsibility for injuries, sickness, pandemics, accidents, natural disasters and/or acts of God incurred during participation in and/or instruction of camps, intensives, private instruction, dance class, fitness class, choreography or any activity I may participate. *

I understand & agree

HOLD HARMLESS *

I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this waiver, release and registration form from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. *

I understand & agree