Little Pink Houses of Hope

As an individual over the age of 18, I freely acknowledge that I have or will voluntarily participate in dance activities held/sponsored by LITTLE PINK HOUSES OF HOPE, (hereinafter “LPHOH”), which may include dance, jumping, and tumbling components. I acknowledge that my participation in dance activities entails both known and unanticipated risks that could result in serious and permanent physical and emotional injuries to myself, death, damage to property, and injury to others. I understand that such risks are inherent in these activities and that even with precautions and safety measures they cannot be eliminated without jeopardizing the essential qualities of the activities. I also understand and acknowledge that injuries I receive(s) may be compounded or increased by negligent rescue operations and as such, I understand that other than telephoning for an ambulance, no medical assistance shall be provided by LPHOH, its agents, staff or other representatives in the event an injury occurs during the event. Understanding such dangers, I hereby knowingly and voluntarily enroll myself in events held/sponsored by members of the LPHOH. I understand that this Form is effective for all events and practices held/sponsored by LPHOH for a 6 month period from date of signature (“effective period”).

I represent that I am in good health and that no condition of mine would constrain me from safely participating in the activities described in paragraph A. I understand that failure to provide information of any health condition that would constrain me from participating could result in serious injuries or death to me. I certify that I have adequate insurance to cover any injury or damage that I may suffer while participating in an event held/sponsored by LPHOH. I agree to bear the costs of any injury or damages I may suffer while participating in any event held/ sponsored by LPHOH. I hereby authorize the LPHOH member holding/sponsoring the event, or representatives to call for medical care for me if medical attention is needed.

On behalf of myself, I hereby knowingly and voluntarily release and forever discharge the LPHOH where I may be/am injured, all LPHOH members, all their respective, employees, agents, coaches, instructors, assistants, officers, directors, and any other representative or affiliates and their respective heirs, successors, and assigns from any and all liability arising out of or in connection with the above-described activities involving myself at any and every event held/sponsored by a member of the LPHOH. “Liability” means any and all claims, demands, losses, causes of action, lawsuits or judgments of any and every kind that occurs during or incidental to the above-described activities, that result from any cause whether caused by the negligence or otherwise.

I hereby agree to and shall indemnify, defend, save and hold harmless LPHOH Representatives from and against any and all loss, liability, damage, or cost they may incur, including attorneys’ fees and litigation costs, arising out of or related to the above-described activities, whether cause by negligence or otherwise.

I hereby agree that the assumption of risk, the release and waiver of liability, and the indemnity agreements contained herein extend to all acts of negligence and is intended to be as broad and inclusive as is permitted by the law of North Carolina, and that if any portion of this Form is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I give LPHOH the right to photograph or video tape me or likeness of me and to disseminate any images or recordings of me for any reproductions associated or in any way connected with marketing, advertising, publication or marketing of any event undertaken by LPHOH. Specifically, I hereby forever and irrevocably grant to LPHOH a license and permission to use any such photographic or video reproduction of me in any form of advertisement for LPHOH or any of its member for promotional purposes. I understand that no compensation will be paid by LPHOH for the use of any photographic or video reproduction of me.

I INTEND BY MY SIGNATURE FOR THIS FORM TO BE A COMPLETE AND UNCONDITIONAL WAIVER AND RELEASE OF ANY AND ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I UNDERSTAND AND AGREE THAT THIS FORM CANNOT BE AMENDED OR MODIFIED BY ANY ORAL STATEMENTS OR OTHER WRITINGS AND THAT IT IS BINDING ON ME AND OUR HEIRS, SUCCESSORS, DISTRIBUTEES, GUARDIANS, LEGAL REPRESENTATIVES, AND ASSIGNS. I AGREE A DIGITAL SIGNATURE SHALL BE BINDING IN LIEU OF THE ORIGINAL.