Informed Consent, Waiver, and Release of Liability.
The participant (hereafter the “Participant”) is voluntarily participating in classes, events, workshops, and other activities at Dance Temple LLC (“Dance Temple”) of their own free will and certifies that they are in proper physical condition to take part in such activities.
If the Participant has questions about whether an activity is suitable for them to pursue, they will consult their health care provider in making that decision. If the Participant has any known physical vulnerabilities, conditions, or injuries, they agree to discuss them with Dance Temple or Dance Temple’s representative before participating.
The Participant certifies that they are at least 18 years of age or older.
The Participant understands that it is dangerous to pole dance under the influence of drugs and/or alcohol and certifies they have not consumed drugs or alcohol before participating in activities at Dance Temple.
Release
By signing this document, the Participant releases Dance Temple and their directors, owners, students, teachers, staff, employees, volunteers, associates (collectively referred to as “Dance Temple” in this document) from any liability or claim that they or their representatives may have against Dance Temple with respect to any bodily injury, personal injury, illness, death, or property loss or damage that may result from their participation at Dance Temple.
The Participant voluntarily releases and forever discharges and holds harmless Dance Temple from any and all claims or demands for damages, loss of services, costs and expenses, injuries, attorney fees, and any other call for reparation from any and all injury to them or their property arising in any way from their participation in dance classes, events, workshops, performances, the use of Dance Temple equipment or facilities, and any activities associated with Dance Temple.
Risks
The Participant understands that there are risks of physical injury associated with, arising out of, and inherent to dancing. These risks include the potential for slips and falls, sprains, strains, dislocations, soft tissue injuries, musculoskeletal injuries, podiatric conditions, and other risks not specified here. Understanding these risks and the potential for others not listed, the Participant agrees to personally accept and assume all of the risks present in their participation at Dance Temple. The Participant’s participation in activities directed or offered by Dance Temple is entirely voluntary, and the Participant chooses to participate in spite of the risks.
Dance education sometimes requires hands-on instruction as well as verbal instruction. Instructors may correct dancers or support (aka “spot”) them by touching their arms, legs, feet, hips, back and head. The Participant acknowledges that this is a common standard in dance instruction and often a safety necessity in pole dance and understands that it is the Participant’s responsibility to communicate clearly with their teacher and/or the director if any form of touch is unacceptable to the Participant.
Medical Treatment and Insurance
The Participant understands that Dance Temple does not assume any responsibility for or obligation to provide financial or other assistance in the event of injury or illness, including but not limited to medical, health, or disability insurance or support.
The Participant authorizes Dance Temple to obtain necessary medical or dental treatment, including first aid, ambulance transport, hospitalization, or such other care necessary for their health and welfare in an emergency. If the Participant’s insurance does not cover emergency treatment that is deemed necessary and sought for them by Dance Temple, the Participant agrees to be responsible for and pay all costs incurred on their behalf. The Participant releases and discharges Dance Temple from any claim which may arise on account of any first aid, treatment, or service rendered in connection with participation in Dance Temple’s activities or with the decision by any representative or agent of Dance Temple to consent to medical or dental treatment on the Participant’s behalf in an emergency.
The Participant understands that Dance Temple does not carry or maintain health, medical, dental, or disability insurance coverage for any participant. The Participant agrees to take responsibility for full payment of any emergency medical or dental costs related to participation in Dance Temple services and activities regardless of whether the Participant has insurance coverage.
Photographic Release
The Participant understands that Dance Temple may take photos and video recordings of the Participant during the Participant’s participation in Dance Temple classes and activities. The Participant conveys to Dance Temple full rights and interest in these recordings. The Participant understands such recordings may be used in advertising or other published materials, physical or virtual.
If the Participant does NOT consent to being photographed or video-recorded, the Participant will make sure Dance Temple is aware of any concerns and the reasons for them, the Participant will be proactive about avoiding being photographed or recorded, and the Participant will hold Dance Temple harmless if a photo or video recording of the Participant is released despite all precautions.
The Participant understands and agrees that any lawsuit filed against Dance Temple must be done solely in the state of Connecticut and agrees that the substantive law of Connecticut shall apply in that action without regard to the conflict of law rules of that state. The Participant agrees that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
Acknowledgment and Signature
By signing below, I acknowledge that I have read this document, understand it in its entirety, and agree to be bound by its terms.
Participant Name: _________________________________ Date: _____________________
Participant Signature: ____________________________________