White Rock Dance

Release Waiver & Hold Harmless

School Name   

Student Name    


Release of Liability

As the legal parent or guardian, I release and hold harmless White Rock Dance and their teachers from any and all claims, past, present or future, known or unknown or any kind or nature, liability, loss, damage, or injury that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of White Rock Dance. Assumption of Risk I/We hereby acknowledge that I/We are aware that the above-name minor will be engaging in physical exercise and activities involving various tumbling and acrobatic equipment which inherently and in their very nature could cause injury to such minor, injuries including, but not limited to muscle strains, sprains, fractures etc. Fully recognizing the potential risks, we hereby assume all risks that such injury(s) may result.

I give my permission for     (Student name) to participate in tumbling classes with White Rock Dance and acknowledge having read the above and fully agree with the Release of Liability & Assumption of Risk. Parent/Legal Guardian


Emergency Contact

Contact Name  

Phone Number  




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White Rock Dance https://whiterockdance.com
Signature Certificate
Document name: Release Waiver & Hold Harmless
Unique Document ID: 11cb38def160996e9bdeb57b1be11c8ea650bd54
Timestamp Audit
2015-06-07 05:53:44 CDTRelease Waiver & Hold Harmless Uploaded by Karissa L Agnew - whiterockdance@gmail.com IP