I/we realize that participation in Kathak dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Neha Pendse Dance Academy LLC. I/we agree to release and hold harmless Neha Pendse Dance Academy LLC including its teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold Neha Pendse Dance Academy LLC liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Neha Pendse Dance Academy LLC. I understand that Neha Pendse Dance Academy LLC is a licensed and insured business. In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to the Owner, Director, Instructor or Staff member as soon as possible.

Dancer’s Name: ______________________________________________ Age: ___________

 Dancer’s Signature: ___________________________________________ Date:___________

(If unable to sign, parent/guardian sign only)

Parent/Guardian Name: ________________________________________ Phone:__________ 

Parent/Guardian Signature: _____________________________________ Date: __________