New Student Waiver

Student's Name *
Student's Name
Registrants must be at least 18 years old or have the written permission of their parent or legal guardian (see below) to participate in classes.
Address *
Phone *
Please provide name and relationship.
Emergency Contact Phone *
Emergency Contact Phone
How did you hear about us? *
I request permission to participate in fitness activities and classes led, assisted, provided, or facilitated by World In Motion LLC. I voluntarily acknowledge that participation is expressly conditioned on my agreement to each of the terms of this document. I agree as follows:
1. I understand that physical exercise, dance classes, and fitness activities may cause injury, and that I am voluntarily assuming all inherent risk of injury when participating in such activities and classes, (hereinafter “Activities”) that are led, assisted, provided, or facilitated by World In Motion LLC and its instructors and/or employees.
2. I recognize and acknowledge that participation in these Activities involves risks of physical injury. I agree to assume the full risk of any injuries (including death), damages, or loss that I may sustain as a result of participating in any and all Activities arising out of, connected with, or in any way led, assisted, provided, or facilitated by World In Motion LLC and its instructors and/or employees including for negligence, and the condition of equipment and premises.
3. I do hereby fully release and discharge World In Motion LLC and their agents, employees and the sponsors, and those whose facilities are being used (the “Released Parties”) from any and all liability, claims, and causes of action, including negligence, for injuries or illness (including death), damages or loss which I may have or which may accrue to me on account of participation in the activities mentioned above. This is a complete and irrevocable release and waiver of liability. I covenant not to sue the Released Parties for any alleged liabilities, claims, or causes of action released hereunder.
4. I further agree to indemnify and hold harmless and defend the Released Parties from any and all claims resulting from injuries or illness (including death), damages, or loss, including, but not limited to attorney’s’ fees, sustained by me arising out of, connected with, or in any way associated with participation by me in the Activities mentioned above.
5. In the event of any emergency, I authorize the Released Parties to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for the immediate care me and agree that I will be responsible for payment of any and all medical services rendered.
6. I have been advised by the Released Parties to consult with a physician before I undertake any physical exercise program. I certify that I am in good health and in sufficient physical condition to properly and safely participate in the Activities mentioned above. 7. I understand and agree that World In Motion LLC reserves the right to use any photograph, video, or other media taken during these activities in World In Motion LLC promotional materials, brochures and/or on related website(s). I READ AND FULLY UNDERSTAND THIS ACKNOWLEDGEMENT, ASSUMPTION OF RISK & RELEASE OF LIABILITY; I AGREE TO BE FULLY BOUND BY ITS TERMS. I REALIZE I AM SUBJECT TO INJURY FROM THESE ACTIVITIES AND NO FORM OF PREPLANNING CAN REMOVE ALL OF THE DANGER TO WHICH I AM EXPOSING MYSELF; I ASSUME ALL RISKS INHERENT IN OUR PARTICIPATION. To sign, type your full name below as you would in your legal signature: I VOLUNTARILY AGREE TO THE ABOVE WAIVER AND RELEASE OF LIABILITY AND ASSUME ALL RISKS INCIDENTAL TO ANY WORLD IN MOTION LLC ACTIVITY.