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Waiver of Liability and Hold Harmless Agreement (Click for downloadable copy) 1. 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 15, 2012 to July 28, 2012 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. 2. 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. 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 ELITE ECOLE TX 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. 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
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 guardianÕs 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____. Student Name: ______________________________________________________________ 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: Work: _______________________________ Other: ________________________________ Email Address: ______________________________________________________________
HEALTH INSURANCE AND POLICY NUMBERS: 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. ____________________________________ _________________________________ ____________________________________ _________________________________ ____________________________________ _________________________________ ____________________________________ __________________________________ ___________________________________ _________________________________ |