Do you verify that you are the parent or legal guardian of the children listed above? *

I am aware that participating in any dance classes, camps and acrobatic dance/tumbling (acro-dance) involves inherent risks and hazards. I freely accept and fully assume all such risks, dangers, and hazards and the possibility of personal injury, property damage, or loss resulting from such risks and hazards. I voluntarily agree to release Grace Christian Dance Company, LLC, Grace Christian Dance Company, LLC’s employees/volunteers/contractors and Danielle Black from any and all liability for any loss, damage, injury or expense that I or my next of kin, successors or dependents may suffer or incur as a result of participation in classes, camps, demonstrations and performances due to any cause whatsoever. *

If I cannot be contacted, I authorize Grace Christian Dance Company, LLC to seek medical services in case of serious injury or illness. I further agree to accept financial responsibility in excess of the benefits allowed by my health plan. *

I understand that Grace Christian Dance Company, LLC, Danielle Black, Grace Christian Dance Company, LLC employees, volunteers and/or contractors will not assume responsibility for any lost or stolen property, or for any bodily or personal injury consisting of or arising out of any participation in any physical training, classes, demonstrations, performances or athletic activity. *

REGARDING COVID-19 – In consideration of my daughter’s participation in on-site classes offered by Grace Christian Dance Company, LLC (the “Organization”), I acknowledge and agree that I am aware that The World Health Organization has declared the novel Coronavirus (COVID-19) to be a worldwide pandemic. I acknowledge that by participating in classes offered by the Organization, my child is at risk of contracting an illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death. *

I will not send my child to class if they have (or anyone in my household has): • Symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days. • Internationally traveled (by sea or air) within the past 30 days. • Visited any area within the United States that was reported to be highly affected by COVID-19, in the last 30 days. • Have been diagnosed to be infected of COVID-19 virus within the last 30 days. • Have been notified that your child has been exposed to someone with COVID-19, in the last 14 days. *

Following the pronouncements above I hereby declare the following: I recognize that my child may be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive and discharge Crossroads Church and Grace Christian Dance Company, LLC, Danielle Black, and all employees and/or independent contractors any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by my child related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19. *