The Dance Place

108 Esplanade STE#230

Lexington, KY 40507

Dear Dancers and or Parent (or Guardian),

We put safety as one of our top priorities, and we will strive to ensure each dancers safety. However,
accidents happen, which are sometimes beyond our control. We are asking each dancer (or parent/guardian)
to sign the following liability waiver form.

Please read and sign the following waiver form:

The Dance Place Liability Waiver Form

I/we realize that participation in The Dance Place could involve some possible personal injury. Despite
precautions, accidents and injuries can occur. By signing this release form, I/we (meaning the dancer and
parent/guardian) assume all risks related to the use of any and all spaces used by The Dance Place. I/we
agree to release and hold harmless The Dance Place, including its teachers and its staff members as well as
the facilities use by The Dance Place from any cause of action, claims, or demands of any nature
whatsoever, now and in the future. I/we will not hold The Dance Place liable for any personal injury or any
personal property damage, which may occur on the premises used during the classes. Furthermore, we
agree to obey the Class and facility rules and take full responsibility for any damage I/we may cause to the
facilities in use by The Dance Place. In the event that I/we should observe any unsafe personal conduct or
unsafe physical condition during the Classes, I/we agree to report the unsafe conduct or condition to a Staff
member as soon as possible.

Thank you in advance for your cooperation,

The Dance Place Staff

Student’s Name: ______________________________________

Student’s Age: ________________________________________

Student’s Signature: ___________________________________

(If unable to sign parent/guardian sign only)

Parent/Guardian Name (print): _____________________________

Parent/Guardian Signature: _______________________________

Date: ______________________________