Waiver and Release of Liability

IN CONSIDERATION OF the risk of injury that exists while participating in COVID-19 RELEASE; and

IN CONSIDERATION OF my desire to participate in said ACTIVITY and being given the right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives, (hereinafter collectively, “Releasor,” “I” or “me”, which terms shall also include Releasor’s parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and discharge Patsy’s Dance Studio, located at 319 W. Main Street, Covington, VA  24426, their affiliates, owner, Patsy Snead, teachers, volunteers, and students, from any physical or psychological injury that I may suffer as a direct result of my participation I the aforementioned Activity.

I am voluntarily participating in the aforementioned activity and I am participating in the activity entirely at my own risk.  I am aware of the risks associated with participating in this activity, which may include, but are not limited to:  Physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, economic or emotional loss.  I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel to and from the activity, or from condition at the activity location(s).  Nonetheless, I assume all related risks, both known and unknown to me, of my participation in this activity.


I hereby acknowledge that I have carefully read this “WAIVER AND RELEASE” and fully understand that it is a release of liability.  I expressly agree to release and discharge Patsy’s Dance Studio and affiliates, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Patsy’s Dance Studio for personal injury or property damage.


In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows:

I HEREBY CERTIFY that I am the parent or guardian of _______________________________



Named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.


PARENT/GUARDIAN NAME: ____________________________________________________________________________


RELATIONSHIP TO MINOR: ____________________________________________________________________________


SIGNATURE: ____________________________________________________________________________


DATE: ____________________________________________________________________________



I, the undersigned participant, affirm that I am of the age of 18 or older, and that I am freely signing this agreement.  I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally.  I am aware that this is a release of liability and a contract that I am signing it on my own free will.


PARTICIPANT’S NAME: ____________________________________________________________________________


SIGNATURE: ____________________________________________________________________________