Dance Creations Dance Studio
Schedule A Complimentary Class
Call Us Now: 217-529-8888
1401 E. Cottonwood St.Springfield, IL. 62703 | dcds91@comcast.net

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Student name

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Parent's name

I do hereby release Janet Cripe of Dance Creations Dance Studio and it's Staff from any liability occurring on or around studio premises, or at any function held at other locations in connection with the dance classes in which the student named above is/are enrolled. I declare that the student named above is/are in good health and can participate in dance education classes. Given the nature of the classes, and with the knowledge that injuries sometimes might occur, I have taken the proper steps to obtain accident, health, or hospitalization insurance, which would cover any sustained injury. In the event of an injury or emergency when I cannot be contacted, I give my permission for you to obtain medical services for the student named above.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.


Dance Creations Dance Studio, from here on known as DCDS, has put in place preventative measures to reduce the spread of COVID-19; however, DCDS cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending DCDS could increase your risk and your child(ren)’s risk of contracting COVID-19.


By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Dance Creations Dance Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death.


I understand that the risk of becoming exposed to or infected by COVID-19 at the studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, DCDS employees, volunteers, and program participants and their families.


I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself, including, (but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at DCDS practice or participation in DCDS programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Dance Creations Dance Studio, it’s employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of DCDS  its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any DCDS program.

Janet Cripe and DCDS may have my permission to publish photo(s) of my Child for any publication representing DCDS, including the school website.

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