VISCOUNT STUDIOS LIABILITY WAIVER

I the undersigned voluntarily agree to assume full and complete responsibility for any injury or accident which may occur to me (or my children) during, or in connection with classes taken at the Viscount Dance Studios. While I am on the premises and I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold The Viscount Dance Studios, its employees, agents, regents, and/or students liable for injury, death, and/or damages sustained by me or my children or property. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive this rights.

I have read, understood and agree to be bound by the above statement (please print your name, sign & date):

print: _________________________________________________

sign & date: ____________________________________________

If signing as a parent or legal guardian, please list the names of student(s) under 18:

© Copyright 2001 Viscount Dance Studios, all rights reserved.