Acknowledgement & Release

Lobby Supervision

This form must be signed for ALL students of MSDA, regardless of number of classes they are enrolled in and before a student between the ages of 7 and up may be unaccompanied between classes. If you have multiple students, please fill out for EACH student individually. For students under the age of 7 years old, they are not allowed to be left at the studio before or between classes and must be picked up immediately following their class, however, we still need you to complete the form.

Location

By signing below, you specifically have read, understand, and agree to the following statements regarding the student you are allowing to be unaccompanied in the studio lobby before, between, and after classes:

I recognize that MSDA does not provide supervision of students attending consecutive dance classes during the break between classes. Therefore, unless the student's parent or legal guardian is present, a student attending consecutive dance classes will be unsupervised after they leave their first dance class and are waiting in the studio lobby for their second class to begin. By agreeing to this Acknowledgement and Release, I am electing for Student (who is at least 7 years old) to be unsupervised before, between, and after his/her dance classes. Further, I agree to instruct Student to not leave the studio for any reason or engage in inappropriate behavior before, between, and after his/her dance classes.

I recognize that permitting a minor child to be unsupervised, by its nature, presents inherent risks of serious physical injury and other harm. I am fully aware of the risks and hazards to Student presented by him/her being unsupervised before, between, and after classes, including but not limited to, Student not finding their next class, unexpectedly leaving the building, wandering into the parking lot, leaving with a stranger, etc. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, EVEN IF ARISING FROM THE NEGLIGENCE OF THOSE PERSONS AND ENTITIES RELEASED FROM LIABILITY BELOW, AND I ACCEPT AND ASSUME FULL RESPONSIBILITY FOR ANY AND ALL INJURIES AND HARM TO STUDENT THAT MAY ARISE AS A RESULT OF PERMITTING STUDENT TO BE UNSUPERVISED.

IN CONSIDERATION OF STUDENT BEING PERMITTED TO BE UNSUPERVISED BEFORE, BETWEEN, AND AFTER CLASSES, I, ON BEHALF OF STUDENT, MYSELF, STUDENT'S OTHER PARENT AND GUARDIAN(S) (IF ANY), AND OUR RESPECTIVE HEIRS AND ASSIGNS (THE "RELEASORS"), HEREBY HOLD HARMLESS, WAIVE, AND RELEASE MSDA AND ALL ITS OWNERS, OFFICERS, DIRECTORS, REPRESENTATIVES, EMPLOYEES, AGENTS, VENDORS, CONTRACTORS, INSURERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE "RELEASEES") FROM AND AGAINST ANY AND ALL LIABILITY, CLAIMS, ACTIONS, AND CAUSES OF ACTION, WHETHER KNOWN OR UNKNOWN, WHETHER NOW EXISTING OR ACCRUING IN THE FUTURE, ON ACCOUNT OF PERSONAL INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, OR OTHER LOSS ARISING OUT OF OR RELATED IN ANY WAY TO STUDENT'S UNSUPERVISED BREAK BEFORE, BETWEEN, AND AFTER CLASSES. THIS RELEASE SPECIFICALLY INCLUDES INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE NEGLIGENCE OF MSDA AND/OR OTHER RELEASEE(S), BUT EXCLUDES INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT OF MSDA AND/OR OTHER RELEASEE(S).

I warrant and agree that I am the parent or legal guardian of Student; that I have the legal right to consent to this Acknowledgement and Release on behalf of Student, myself, Student's other parent and guardian(s), if any, and our heirs and assigns; and that by signing below, we hereby do consent to the terms and conditions of this Acknowledgment and Release.

Please select option below