Golden Bridge ~ Movement Mass
STANDARD RELEASE & WAIVER OF LIABILITY
  • BY MY SIGNATURE HEREUNDER, I enter Movement Mass, sponsored by Golden Bridge (GB), Melissa Michaels (MM), Melissa Michaels Movement, LLC (MMM), SomaSource (SS), and acknowledge that I fully comprehend the activities I will be involved in as a participant in this dance event. I UNDERSTAND AND APPRECIATE THE KNOWN AND UNKNOWN DANGERS IN PARTICIPATING IN THIS DANCE EVENT, AND I VOLUNTARILY ASSUME THESE RISKS.
  • THEREFORE, in consideration of Golden Bridge (GB), Melissa Michaels (MM), Melissa Michaels Movement, LLC (MMM), SomaSource®'s (SS) sponsorship of this dance event, and based upon my representation that I am in proper physical health and condition to participate, I agree:
  • 1. that participation in, Movement Mass is voluntary, and that there are inherent risks in dancing and the other physical activities that are part of this dance event, thus I fully assume those risks. Specifically, I am aware that dancing and physical activities associated with dancing have known and unknown risks which include, but are not limited to physical injuries such as broken bones, torn tendons or muscles, sprained ankles or other joints, as well as possible falls, concussions, or aggravation of pre-existing physical conditions. I hereby release GB, MM, MMM, SS and any of their officers, employees, faculty, volunteers or agents, from any liability for injuries sustained or illnesses contracted while in attendance.
  • 2. that in case of physical injury or medical emergency, I hereby authorize GB, MM, MMM, SS, and any of their officers, employees, faculty, or agents to make necessary arrangements for me to get to a medical treatment facility as needed. In an extreme emergency, and if I am under 18 years of age, I understand that GB, MM, MMM, SS and any of their officers, employees, faculty, volunteers or agents will make every attempt to notify the person(s) I have named as my emergency contact(s) of my condition, location, and way to contact me.
  • 3. that it is my sole responsibility to safeguard my personal property and will not hold GB, MM, MMM, SS, and any of their officers, employees, faculty, volunteers or agents for the loss or damage of my personal property while in attendance at Movement Mass dance event.
  • 4. to abide by guidelines, regulations, and policies set forth by GB, MM, MMM, SS, and any of their officers, employees, faculty, volunteers or agents while in attendance.
  • 5. for myself, my heirs, executors, administrators, personal representatives and assigns, to indemnify, release, forever discharge and hold harmless GB, MM, MMM, SS, and any of their officers, employees, volunteers or agents from any and all liability for any injury, including death, and for property damage or loss which may be suffered by me, judgments arising from acts or omissions committed, arising out of or in any way connected with my participation in this dance event.
  • 6. to grant to GB, MM, MMM, SS the right without limitation to use, in whole or in part, my name, likeness, physical likeness, voice, biography, interview and performance in connection with any Golden Bridge programs/events in perpetuity, in all known and hereafter existing media, in any form, including photograph, picture, artist’s rendering, silhouette or other reproduction by film, tape or otherwise. I agree that GB, MM, MMM, SS and their successors and assigns, shall be the exclusive owner of all copyright and other rights in and to such taping and will be able to license others to use them in any manner.
  • I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY, AND A CONTRACT BETWEEN MYSELF AND GOLDEN BRIDGE, MELISSA MICHAELS, MELISSA MICHAELS MOVEMENT, LLC, SOMASOURCE AND I SIGN IT KNOWINGLY AND OF MY OWN FREE WILL.

    For participants under eighteen (18) years of age, both the participant and the parent/legal guardian need to sign the document. See the section below for the parent/guardian's signature.
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  • Please use your track pad, mouse, stylus or finger to sign on the line above.
  • PARENT OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

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  • Please use your track pad, mouse, stylus or finger to sign on the line above.
  • EMERGENCY CONTACT INFORMATION

    Please provide us with the name and contact information for the person you would like us to contact in case of an emergency.
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