TANGO PRIVATE CLASSES: Angela or Roy

If you need to CANCEL and want credit, you MUST CALL, EMAIL OR TEXT ME. Otherwise your class WILL NOT BE CREDITED OR REIMBURSE. If you CANCEL, you have 8 WEEKS to redeem your class from the last class you took.

WAIVER OF LIABLITY AND MEDICAL AUTHORIZATION: I, the undersigned, hereby consent to the aforementioned student participating in or watching dance, dance workshops, audition, rehearsal, events or performance and other related activities (collectively “Activities”) with TANGO IN SAN ANTONIO. I recognize that and assume all liability for potentially severe injuries, including permanent paralysis or death can occur in any activities including, but not limited to, those involving height, exercise, dance or motion. I hereby release TANGO IN SAN ANTONIO, its owner(s), agents, volunteers, assistants, employees, guest artists, instructors and staff members from any and all liability claims, demands, or causes of action whatsoever from any and all damages suffered by the student while under the instruction or supervision of TANGO IN SAN ANTONIO. I also agree to release and hold harmless TANGO IN SAN ANTONIO, including its owner(s), instructors and its staff as well as the facilities used by TANGO IN SAN ANTONIO, from any cause of action, claims or demands of any nature whatsoever arising from or out of the activities. I also fully understand that the owner(s), instructors and staff at TANGO IN SAN ANTONIO are not physicians or medical practitioners or any kind. With that in mind, I hereby authorize owner(s), instructors and staff at TANGO IN SAN ANTONIO the render first aid to the student in the event of any injury or illness, and if deemed necessary, to call an ambulance or for medical aid and payment of for which I agree to be solely responsible. I further agree to provide health insurance for the student and/or guarantee payment of any medical expenses incurred as a result of activities a t or with TANGO IN SAN ANTONIO. This Waiver of Liability and Medical Authorization has been read thoroughly and understood completely by me and as such is acknowledged by my voluntary signature below.

PHOTOGRAPH AND VIDEO RELEASE: I grant permission for student to be photographed or videotaped during activities at or with TANGO IN SAN ANTONIO and grant TANGO IN SAN ANTONIO permission to use such recordings for promotional purposes. Such recordings are the sole property of TANGO IN SAN ANTONIO.

TANGO IN SAN ANTONIO TERMS AND CONDITION / MISCELLANEOUS: I acknowledge that I have read and agree to the attached TANGO IN SAN ANTONIO Terms and Conditions, which are part of this agreement and may be changed, upon reasonable prior notice, at any time by TANGO IN SAN ANTONIO without my consent. This Student Agreement and Liability Waiver shall be governed by and interpreted under the laws the state of Texas, excluding its choice of law rules. Any dispute arising under this Student Agreement and Liability Waiver shall be brought in the courts located in San Antonio County, Texas.

I have read, completed, understand and agree to all of the previous information. I also understand that I am entitled to copy of the Student Agreement and Liability Waiver upon request.

• I AGREE