Ethnic Dance Expressions
School of Belly Dance
Gainesville, Florida
Registration and Release Form

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I, the undersigned, understand there are physical risks associated with dance and exercise of any kind and I knowingly and voluntarily accept that risk and I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in these classes, workshops, performance and activities offered by Ethnic Dance Expressions, its owner (Marjorie Malerk), employees or agents. I expressly assume all risks and take full responsibility for any injuries, damages, or losses which I may incur as a result from these activities, and I, the undersigned, for myself, heirs, administrators, and executors, do hereby fully forever release and discharge Ethnic Dance Expressions, Marjorie Malerk individually, and its staff from any and all claims, demands, damages, rights or actions or causes of action, present or future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my participation in the classes, workshops, or other activities. I, the undersigned, do hereby authorize Marjorie Malerk or her designated agents to obtain medical treatment for myself in emergency situations if needed. I understand that I am responsible for any medical expense and that the absence of health insurance does not make Marjorie Malerk or Ethnic Dance Expressions responsible for payment of my medical expenses. Ethnic dance Expressions will make no evaluation or recommendation whether students or guest are sufficiently fit for any exercise or dance activities. It is always advisable to consult your physician before undertaking a dance or physical exercise program. I, the undersigned have carefully read this waiver and fully understand it is a release of liability. (A Parent's or Legal Guardian's Signature is required if student is under 18).

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Shands
NFRH
VA

Please note any medical or physical limitations, allergies, etc. that may affect participation: A value is required.

Allergies to medications: A value is required.