Dance Revolt Participant Waiver



Dance Revolt Participant Waiver  All participants and accompanying staff MUST complete this form before participating in Dance Revolt. If participant is under age 18, a parent or guardian must also sign this form.

Admission to class and/or rehearsals will not be granted if this form is not received prior to class and is not properly signed.

Waiver of Liability for:

Student Info

Parent/ Guardian Info



I, , recognize and understand the risks of physical injury inherent to dance and dance training and I fully assume those risks. I hereby release Just BGRAPHIC, event sponsors, employees and dance teachers from all liability for injuries sustained or illnesses contracted while attending or participating in any dance classes, rehearsals, workshops, or performances. I agree to indemnify, defend, and hold harmless Just BGRAPHIC, employees and dance teachers for liabilities, costs and judgments arising from acts of omissions committed by me or my child which result in injury or damage to any person or property. Initials:

Protection of Property

I understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in Dance Revolt , rehearsals, workshops, or performances. I hereby release Just BGARPHIC, its affiliate dance studios, event sponsors, employees and dance teachers from all liability for loss or damage to my personal property while attending or participating in classes, rehearsals, workshops, or performances. I also agree to abide by any rules, regulations and policies set forth by Just BGRAPHIC.

Medical Attention

In case of physical injury or medical emergency, I hereby authorize Just BGRAPHIC to make necessary arrangements to transport myself or my child to a medical treatment facility as necessary. In extreme emergency, or if my child is under 18 years of age, I understand that Just BGRAPHIC will attempt to notify the person(s) I have named below as my emergency contact(s) of my condition and how to reach me. 

Photo Release

Just BGRAPHIC reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting Just BGRAPHIC and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify Just BGRAPHIC prior to participation in class. 

Acknowledgement of Waiver

In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and am fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my or my child’s participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me or my child.


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Signed by Kayode Brown
Signed On: March 24, 2023

Signature Certificate
Document name: Dance Revolt Participant Waiver
lock iconUnique Document ID: 5f860d3a4e4ec5a463575098ce108e31d422c2df
Timestamp Audit
September 16, 2022 9:57 am ESTDance Revolt Participant Waiver Uploaded by Kayode Brown - IP 2607:fea8:23de:cc00:98cd:f60e:806:c5ca,2607:fea8:23de:cc00:98cd:f60e:806:c5ca