THE ELITE ECOLE TX
and
St. Mary’s University
Waiver of Liability and Hold Harmless Agreement
Waiver of Liability
and Hold Harmless Agreement
- In the
consideration of The Elite Ecole TX providing the opportunity for
and permitting the undersigned (Participant) to participate and take part
in The Elite Ecole TX and its related activities, July 21, 2010
to July 31, 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
Elite Ecole 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 Elite Ecole 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.
- We recognize and
acknowledge that certain risks of harm are or may be inherent in the
various activities contemplated herein and that The Elite Ecole TX 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 Elite Ecole 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.
- 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.
- I UNDERSTAND
THAT THE ELITE ECOLE TX WILL NOT BE RESPONSIBLE FOR ANY MEDICAL
COSTS ASSOCIATED WITH ANY INJURY THAT I OR MY CHILD MAY SUSTAIN.
- 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.
I / We agree
that I or my child (Participant) will adhere to the Rules and Regulations
promulgated by The Elite Ecole 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: ___________________________________________________
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
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