2011-2012 REGISTRATION FORM
The Dance Matrix

Waiver of Liability

THIS CONSENT, RELEASE AND WAIVER is executed on date that this form is electronically submitted, by the undersigned on behalf of himself/herself and the student (the “Child”), and their legal representatives, heirs and assigns (collectively the “Undersigned”), as parent and/or guardian of the Child, and is delivered to The Dance Matrix, its officers, directors, shareholders and employees.

The Undersigned hereby grants his/her permission for the Child to participate in classes conducted by The Dance Matrix. The undersigned hereby releases, waives and discharges The Dance Matrix, its owners, members, advisers, Board of Directors, and all employees and agents of these parties from all liabilities, suits, claims. and/or demands of any kind or nature, legal or financial, whether caused in any way by the negligence or not, arising from the participation in or observation of any The Dance Matrix activity for injuries to any person or property, whether on or off the premises

The student/participant named above does voluntarily participate in any and all The Dance Matrix activities and that the student/participant understands that certain risks are inherent to and from participation and involvement with The Dance Matrix and in its various formal and informal activities. These activities include but are not limited to Dance and Gymnastics.

Medical Release

As the parent/legal guardian of the student/participant named above, I request and authorize that in my absence the student/participant named below be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine/Osteopathy or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the student/participant named above. I have not been given any guarantee as to the results of examination or treatment. I hereby authorize The Dance Matrix, its owners, members, Board of Directors, and all employees and agents of these parties to act for the student/participant named above according to their best judgment in providing or arranging for emergency care in any emergency circumstance requiring medical attention. I authorize the hospital, medical or care facility to dispose of any specimen or tissue during the course of any diagnosis, treatment or other normal and customary procedures.

Non Compete Clause

The non compete clause applies to students, employees, teachers, assistants, apprentice, mentors, helpers and anyone associated with The Dance Matrix., the undersigned hereby agrees not to directly or indirectly compete with the business of the Company and its successors and assigns during the period of and for a period of two years within 15 miles of The Dance Matrix business location following departure from service at The Dance Matrix unless written approval is granted.  All choreography, music, commercials, mixed music, routines, lesson plans, forms, documentation, trade secrets, ideas, advertisement, and techniques, are the sole property of The Dance Matrix and should not be copied, duplicated, reproduced, or removed from the studio in any manner unless permission is granted from The Dance Matrix. The term "not compete" as used herein shall mean that any person teaching, renting, instructing classes shall not own, manage, operate, consult or be employed payed or non paying position in a business substantially similar to, or competitive with, the present business of The Dance Matrix or such other business activity in which The Dance Matrix may substantially engage during the term of enrollment with The Dance Matrix.

Photo Release

I hereby understand and am fully aware that the student/participant named above may be participating in The Dance Matrix activities in which I and/or the student/participant named above may be photographed or videotaped (the Property) from time to time. I hereby irrevocably grant to The Dance Matrix perpetually, exclusively, and for all media throughout the world (including print, non theatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs, sound bites or video footage taken as a result of participation in The Dance Matrix activities. I hereby agree that I will not bring or consent to others bringing claim or action against The Dance Matrix on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on me or the student/participant named above, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release The Dance Matrix, its owners, members, Board of Directors, and all employees and agents of these parties from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have against The Dance Matrix in connection with the Property. This agreement shall not obligate The Dance Matrix to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Property. The Dance Matrix shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, corporation or organization

The Undersigned expressly agrees that this Consent, Release and Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion thereof is held to be invalid, it is agreed that the balance will continue in full force and legal effect. The Dance Matrix  is not responsible for any lost or stolen property, at any time

Anyone found to be violating any of the rules, codes of conduct, or found to be disruptive to either another individual or group may be asked to leave the premises or off-site location at any time and be refused re entrance without any full or partial refund

IN WITNESS WHEREOF, the Undersigned has executed this Consent, Release and Waiver as of the date first written above.

Release and Waiver of Liability and Indemnity Agreement (Read Carefully Before Signing)

 In consideration of being permitted to participate in any way in the Dance Program indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:

1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below dance activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.

2. I/WE fully understand and acknowledge that:

(a) There are risks and dangers associated with participation in Dance events and activities which could result in bodily injury partial and/or total disability, paralysis and death.

(b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.

(c) These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releases named below.

(d) There may be other risks not known to us or are not reasonably foreseeable at his time.

3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releases named below.

4. I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the dance facility used by the participant , including its owners, managers, teachers, instructors, promoters, lessees of premises used to conduct the dance event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the dance facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as “Release”...FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE.

5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.

6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.

7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite this release, the participant makes a claim against any of the Releases, the parent(s) and/or legal guardian(s) will reimburse the Release for any money which they have paid to the participant, or on his behalf, and hold them harmless.

I HAVE READ THE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY PRESSING SUBMIT AND ELECTRONICALLY SIGNING IT, AND HAVE ELETRONICALLY SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY ELECTRONIC SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Registraion Form

Please remember there is a $25 registration fee to be paid in full with the first month's tuition on the first day of class.

This form is only to save your child's spot in classes and does not serve as a substitute for the paper registration form that must be filled out and signed in person by the parent/guardian on the first day of class.