Student Information & Liability Waiver and Acknowledgement of Risk Form
READ AND SIGN BELOW
REGISTRATION IS INCOMPLETE WITHOUT FILLING UP FORM AND MUST BE COMPLETED BEFORE CLASS (ONLY ONCE)
I understand and agree that in participating in any dance, workshop, rehearsal or performance, there a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me during any of Esteban Conde dance classes, rehearsals, performances or activities.
I also exempt, release and indemnify Esteban Conde, the dance studio or venue where classes or events are held, agents, volunteers, assistants, employees, guests artists, members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Esteban Conde. i further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Esteban Conde, dance studio or venue where classes and/or events are held, agents, volunteers, assistants, employees, guest artists, members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. I certify that I am the parent or legal guardian and I have the right to waive these rights.
Permission is granted to use photograph and/or video of students for publicity purposes. I have read, understood and agree to be bound by the above statement.
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that OC Salsa has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that OC Salsa can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.
I voluntarily seek services provided by OC Salsa and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold OC Salsa harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the business, or that may otherwise arise in any way in connection with any services received from OC Salsa. I understand that this release discharges OC Salsa from any liability or claim that I, my heirs, or any personal representatives may have against the business with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from OC Salsa. This liability waiver and release extends to the Business together with all owners, partners, and employees.