CREATIONS REGISTRATION SUMMER 2022

CHILD:

Child's Name (If you have multiple children, please complete separate registration forms for each child.)

Age

Date of Birth

Food Allergies

Previous Dance Experience

PARENT/GUARDIAN (1-Primary):

Parent/Guardian Name

Email

Phone

Address

PARENT/GUARDIAN (2):

Parent/Guardian Name

Email

Phone

Address

CANCELLATION POLICY
No refunds issued for natural, unexpected, unforeseen and uncontrollable environmental events.

EMERGENCY CONTACT 1):

Name

Phone

Additional Phone

EMERGENCY CONTACT 2):
Name

Phone

Additional Phone

DOCTOR NAME

DOCTOR PHONE

Does child have any special medical considerations?

I understand every effort will be made to contact me, the contact person, or the doctor. If we cannot be reached, I give my consent for staff to administer first aid, and for an emergency room physician to treat myself, my child, or my family. I agree that I will be financially responsible for all charges and fees incurred in rendering treatment.

I, the adult applicant, or I, the parent or legal guardian of the applicant listed above, hereby give approval of the applicant’s participation in any and all of Creations' (dba Creations Berkeley) programs and activities registered above. I waive, release, absolve, indemnify, and agree to hold harmless the organizers, sponsors, supervisors, volunteers, counselors, participants, and persons involved in the operation of Creations (dba Creations Berkeley) programs for any claims arising out of injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or as a spectator.

WAIVER AND RELEASE OF LIABILITY

IN CONSIDERATION OF the risk of injury that exists while participating in Creations Sessions (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge CREATIONS , located at 1640 MLK WAY , Berkeley , California 94709, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Creations to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment.

I am aware and understand that I should carry my own health insurance.

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Creations official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY
UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE
Creations AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Creations FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Creations , its agents, and employees. I agree that this Release shall be governed for all purposes by California law, without regard to any conflict of law principles.

This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of
neglect or recklessness. THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both Participant and Creations agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

MEDIA RELEASE FORM (VIDEO + PHOTO)
I hereby grant permission to Creations (hereinafter referred to as the “Media”), to use or post my image (video and/or photographs) (hereinafter referred to as “Materials”) for use in Media publications including: (Check All That Apply)

VideosMagazinesNewslettersGeneral PublicationsRecruiting BrochuresE-mail BlastsWebsite and/or Affiliates

I hereby waive my right to inspect and/or approve the Materials, whether they are known to me or not, and whether for present or future use. I shall receive no compensation nor royalties arising from the said use of the Materials.

Please check the box that is appropriate for your present situation:

[checkbox* IHAVREAD use_label_element "I am 20 years of age and older and of sound mind to contract in my name. I have read this release before signing below, and I have read, fully understood, and consent to the contents of this release. I am aware that I am free to address any questions prior to the signing of this release and failure to do so will be considered as a free and knowledgeable acceptance of the terms of this release. I, the adult applicant, or I, the parent or legal guardian of the applicant listed above, hereby give approval of the applicant’s participation in any and all of The Studio’s programs and activities registered above. I do waive, release, absolve, indemnify, and agree to hold harmless the organizers, sponsors, supervisors, participants, and persons involved in the operation of The Studio’s programs for any claims arising out of injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or as a spectator. I also give permission for The Studio to take photos of me or my child to use for the website and for purposes of promoting the school. If any child exhibits behavior that is dangerous to himself/herself or to other students, The Studio reserves the right to remove the child from the school. SIGNATURE: I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL. I agree that by typing my full name I am representing my signature and agreement to the above. SIGNED: [text* guardian-signature]