Springfield:6100 S Second Street Suite C
View Larger Map
Taylorville:107 W. Main Cross
Date of Birth
Parent Responsible For Account
Mother Cell Phone
Father Cell Phone
Mother's Company Address
Mother Work Phone
Father's Company Address
Father Work Phone
Child's Class Day
Child's Class Time
Child's Class Teacher
Additional Information you wish for us to know about your child
Fill us in...
Only humans can dance...
Liability Waiver and Release
I attest, as a participant, or as the legal guardian of the minor referred to as participant in TurnOut Movement Arts Studio dance classes, that should the participant take part in the aforementioned dance/fitness/arts programs, the participant is physically fit to participate in the physical activity program known as and associated with any TurnOut Movement Arts Studio dance/fitness/art classes.
In participating in TurnOut Movement Arts Studio dance/fitness/arts classes, including, but not limited to any individual or group classes, workshops, or other activity organized by TurnOut Movement Arts Studio, I hereby waive and release all claims, liabilities, actions, damages, costs or expenses of any nature whatsoever for injuries the participant might sustain, known or unknown, arising out of the program now or at all times in the future.
I understand that certain corrections may include manual physical contact and manipulation. I recognize and acknowledge there is risk associated with participating in the activities associated with the instruction of dance/fitness/arts, and I agree to assume total risk of any such activities connected with TurnOut Movement Arts Studio dance/fitness/arts classes. I accept liability for any property damage that may occur as a result of participant's instruction, and I understand and accept that no promises or guarantees are made, explicit or implied.
The registered participant or, in case of a minor their parent(s) or guardian(s) agrees to indemnify and hold harmless TurnOut Movement Arts Studio, Progressive Kenpo Jitsu International or any instructors associated to the program, from and against any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, known or unknown, incurred by TurnOut Movement Arts Studio and arising out of or in any way related, directly or indirectly, to the participation of the classes. By registering, I agree to the terms outlined in this liability waiver and release. I also agree to abide to all TurnOut Movement Arts Studio policies and regulations.
If registering a student who is minor under 18 yrs, please enter the parent/guardian name.
I have read and agree to the above wavier.
I hereby grant the TurnOut Movement Arts Studio, (hereafter known as TurnOut) the absolute and irrevocable right and unrestricted permission in respect of photographic portraits of pictures taken of me or in which I may be included with others, to copyright or the same, to use, reuse, publish and republish the same in whole or in part, individually or in conjunction with other photographs, and in conjunction with other printed matter, in any or all media now hereafter known, for any purpose whatsoever without restriction as to alteration and to use my name in connection therewith if TurnOut so chooses.
I hereby waive any right that I may have to inspect and/or approve the finished production or the advertising copy that may be used in connection therewith, or the use to which it may be applied.
I hereby release and discharge TurnOut from any and all claims and demands arising out of or in connection with the use of the photographs, including without limitation any and all claims for libel or invitation of privacy.
This authorization and release shall also insure to benefit of the heirs, legal representatives, licensees, and assigns of TurnOut.
I am of full age and have the right to contract in my name. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me and my heirs, legal representatives, and assigns.
I agree to the above terms.
Thank you for your submission. You will be contacted soon.
Copyright © 2011 TurnOut Movement Arts Studio. All Rights Reserved.Website by Defining Dimensions of Taylorville, IL.