THE

JOFFREY WORKSHOP TX

and

St. Mary’s University

Waiver of Liability and Hold Harmless Agreement

 

1. In the consideration of The Joffrey Workshop TX providing the opportunity for and permitting the undersigned (Participant) to participate and take part in The Joffrey Workshop TX and its related activities,

      June 26, 2010 to July 17, 2010 the undersigned Participant and Parent of           the Participant, do hereby release, remise and forever discharge, indemnify and agree to HOLD HARMLESS WAIVE, DISCHARGE, and      COVENANT NOT TO SUE  The Joffrey Workshop TX, its officers,       employees, faculty, instructors, servants, agents and assigns, hereinafter             referred to as RELEASEES, from any claim, demand or cause of action           whether now in existence, or hereafter arising for any loss of personal      property, injury to the Participant or for the death of the Participant, arising         out of resulting from, caused by or contributed to in whole or in any part by       any action or failure to act, negligence, breach of contract, or other misconduct on the part of The Joffrey Workshop TX, its officers, faculty, agents, servants, employees, (RELEASEES) any other Participant in said          workshop, any participating parent and/or any one or more of any thereof.

 

2. We recognize and acknowledge that certain risks of harm are or may be inherent in the various activities contemplated herein and that The Workshop or University cannot control all of these risks.  We are aware that ballet training and the gymnastic exercises associated with it place unusual stress on the body and carry with them the risk of physical injury.  I / We assume the risks involved.  I / We also understand that dance instruction involves kinetic correction that may include physically touching the student (Participant) as part of the regular class work and/or rehearsal.  I / We assume the risk and agree that The Joffrey Workshop TX faculty have permission to engage in appropriate kinetic correction of the body for technical corrective purposes as part of regular class work and rehearsal.

 

3. It is my/our express intent that this Release and Hold Harmless Agreement shall bind the members of my/our family if I am alive, and my heirs, assigns and personal representative, if I am not alive.  It shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above named RELEASEES.  I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas.

 

4. I UNDERSTAND THAT THE JOFFREY WORKSHOP WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH ANY INJURY THAT I OR MY CHILD MAY SUSTAIN.

 

5.    I / We also understand that I / we should and am / are urged by RELEASSEES to obtain health and accident insurance to cover any personal injury to me / my child (Participant), which may be sustained. 

6.    I / We agree that I or my child (Participant) will adhere to the Rules and Regulations promulgated by The Joffrey Workshop TX and obey all

      laws of the State of Texas while participating in this activity.

 

            IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I /     We  have read the foregoing Waiver of Liability and Hold Harmless Agreement,      understand it and sign it voluntarily as my / I own free act and deed; no oral representations, statements or inducements, apart from the foregoing written      agreement, have been made; I am at least eighteen (18) years of age and fully             competent or, if I am under eighteen (18) years of age, my parent or legal guardian’s approval and signature has been obtained; and I / we execute this      Release for full, adequate, and complete consideration fully intending to be           bound by the same.

 

IN WITNESS WHEREOF, I have hereunto set my hand on this  _______ of _______,  20_____

       Day             Month           Year

 

Student Name: _________________________________________________________________

                            Please Print

 

If 18 years of age or over:      Yes __________   No __________

 

Participant Signature: _________________________________________ Date: _______________

 

Participant Printed Name: __________________________________________________________

 

Participant Address: _______________________________________________________________

 

Participant Home Phone Number: ____________________________________________________

 

Participant Cell #: _________________________  Email Address: __________________________

 

 

 

EMERGENCY INFORMATION:           Person(s) to be contacted in case of emergency:

 

Name:                                                                                                 Relationship:

           

_______________________________________________________________________________

 

Phone Numbers:

 

Home: ___________________________________ Cell: _________________________________

 

 

Work: ___________________________________ Other: ________________________________

 

 

Email Address: _________________________________________________________________

HEALTH INSURANCE AND POLICY NUMBERS:

 

 

Name of Insurance Company: ____________________________________________________

 

 

Health Insurance Group Number: _________________________________________________

 

 

Policy Number: ________________________________________________________________

 

 

Address: _____________________________________________________________________

 

 

City: _______________________________________ State: ___________ Zip:_____________

 

 

Insurance Company Telephone Number: ___________________________________________

 

 

*****************************************************************************************************************

 

 

                       WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

           

If I am under the age of eighteen, I have read, understood, and discussed the above content with my parent or guardian identified below. We hereby accept the terms and conditions as stated in this document.

 

                   

______________________________________        ____________________________________

Participant Signature                          Age                  Parent / Guardian Signature

 

 

______________________________________        ____________________________________

Printed Name                                                              Printed Name

 

 

______________________________________        ____________________________________

Address                                                                       Address

 

 

______________________________________        ____________________________________

City / State / Zip                                                         City / State / Zip

 

 

______________________________________        ____________________________________

Date                                                                           Date