DIVINITY STUDIO

LIABILITY WAIVER

First Name

Do you have an existing injury or health condition that we should be aware of?

Yes

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Please specify anything we should know about:

Initials

I declare that the info I’ve provided is accurate & complete

I acknowledge that I am participating in Divinity Studio class/event/workshop/rehearsal/or activity, to be referred to as the “Activity.” By voluntarily participating in the “Activity,” I acknowledge that I am exposing myself to potential dangers and risks, including, without limitation, personal injury, injuries to others, injury to property, bodily harm and/or death. I HEREBY ASSUME ALL OF THE RISKS OF MY PARTICIPATION, including, by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of Divinity Studio LLC, and related and affiliated companies, shareholders, directors, officers, contractors, employees and agents. I HEREBY FOREVER WAIVE, RELEASE, REMISE, DISCHARGE, INDEMNIFY AND SAVE HARMLESS EACH OF THE WORKSHOP HOST, AND WORKSHOP HOST’S RELATED AND AFFILIATED COMPANIES, SHAREHOLDERS, DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS FROM AND AGAINST ALL PAST, PRESENT OR FUTURE CLAIMS AND LIABILITIES OF WHATSOEVER NATURE (INCLUDING, WITHOUT LIMITATION, LIABILITY FOR ANY PERSONAL INJURY, INJURIES TO OTHERS, BODILY HARM AND/OR DEATH) IN RESPECT OF OR ARISING DIRECTLY OR INDIRECTLY, IN ANY MANNER FROM ANY PARTICIPATION IN THE WORKSHOP, WHETHER DURING CLASSES, BREAKS OR OTHERWISE DURING THE WORKSHOP. I HEREBY ACKNOWLEDGE that I have read this Release thoroughly and I fully understand it. I am voluntarily executing this Release and would not otherwise be permitted to participate in this activity. I acknowledge that this release restricts me from suing or otherwise claiming against the Divinity Studio LLC, presently or at any future time, for damage, loss, or injury (as specified above), including death, that may occur as a result of my visit. IN ADDITION TO THE ABOVE, I HEREBY CONSENT to the use of my name, likeness, portrait, picture or photograph, and acknowledge and agree that my name, portrait, likeness, picture or photograph may be used on the Divinity Studio LLC. website or social media, including, without limitation, Facebook, Instagram and Twitter, and in promotional products, including, without limitation, publications, commercial tie-ins, videos, posters and displays

Your Signature

Thanks for submitting!

DIVINITY STUDIO

LIABILITY WAIVER

436 Lincoln Blvd #206

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