Covid Health Afidavit | thestarliteballroom

Class policies & Covid-19 Declaration

First Name

Last Name

I agree that upon enrolling in a class, the class registration is valid through the duration of the class, package of lessons, or session. I agree to notify Starlite Ballroom at least 24 hours in advance to cancel or change any private lesson or appointment or I will be charged. Makeup classes may be taken for missed classes in any available and similar class, and students are encouraged to do so.

I and my child agrees to touch-lesstemperature checks and that a mask must be worn at all times for anyone over the age of 5.

I am not experiencing the symptoms: fever, cough, loss of taste or smell, new muscle aches, new headaches, sore throat and I haven’t been in close contact with a Covid-19 patient in the last 14 days

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19: In consideration of being allowed to participate in dance lessons or on behalf of Starlite Ballroom and any related events and activities, I acknowledge, appreciate, and agree that: Participation by me or my child includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (as defined below) or others, and assume full responsibility for my participation and for my child’s participation; and, I acknowledge that I increase my risk of exposure to COVID-19 by participating in dance lessons and services rendered. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself or my child from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Starlite Ballroom and its officers, owners, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, or any causes of action, claims, demands, costs, expenses and compensation for damage, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

In consideration of being allowed to participate in dance lessons or on behalf of Starlite Ballroom and any related events and activities, I acknowledge, appreciate, and agree that: Participation by me or my child includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (as defined below) or others, and assume full responsibility for my participation and for my child’s participation; and, I acknowledge that I increase my risk of exposure to COVID-19 by participating in dance lessons and services rendered. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself or my child from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Starlite Ballroom and its officers, owners, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, or any causes of action, claims, demands, costs, expenses and compensation for damage, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

WAIVER OF LIABILITY AND ASSUMPTION OF RISK: I or We, the undersigned person, persons or party as a student or participant of Starlite Ballroom voluntarily makes and grants this Waiver and Assumption of Risk in favor of Starlite Ballroom in addition to monies paid to Starlite Ballroom for the opportunity to use the facilities, equipment, materials and/or other assets of Starlite Ballroom; and/or to receive assistance, training, lessons, guidance, tutelage and/or instruction from the personnel of Starlite Ballroom; and/or to engage in the activities, events, sports, festivities and/or gatherings sponsored by Starlite Ballroom; I or We do hereby release Starlite Ballroom, its employees, contractors, owners, officers, agents, and all persons affiliated with Starlite Ballroom, and the City of San Jose from all claims, liability, lawsuits or actions of every name, kind and description, brought for, or on account of injury of any type, or any injury connected with participation in any activity by participant, observer, renter, or servant of the renter of Starlite Ballroom space, any damages, losses and/or death that may arise from aforementioned use. The undersigned acknowledges, understands, and recognizes that there are certain risks, dangers, and perils connected with such use, and nevertheless accepts, assumes and undertakes the consequences including, but not limited to such injuries, death or damage caused by the concurrent active or passive negligence of Starlite Ballroom and affiliated parties, where such injuries occurred in, upon, or in any manner by reason of the participants or renters use of the Starlite Ballroom premises or property or possessions. I or We further agree to use the best judgment in undertaking these activities and to fully adhere to all safety instructions and recommendations, whether oral or written. For online learning, the undersigned agrees to perform activities in an open area free from obstacles and assumes the risk of injury to self, others, and property. This Waiver of Liability and Assumption of Risk is effective during the time of registration, inclusive, and may not be revoked, altered, amended, rescinded or voided without the express prior written consent of Starlite Ballroom.

TUITION FEES FOR CLASSES: I agree to pay the tuition and fees that is set forth in my dance class enrollment form/ agreement with Starlite Ballroom. All tuition payments must be made in a timely manner, by the due date set forth in the enrollment form. All class registration fees are non-refundable unless specified by Starlite Ballroom. I understand that failure to pay on or before the 10th of each month will incur a $10.00 late fee, which will be charged to my account. Balances over one (1) month past due may also be assessed a 10% late fee. All registration for lessons is at the discretion of Starlite Ballroom, and registration may close due to full classes or towards the end of a session or season.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION): This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE to the fullest extent provided by law.

PHOTOGRAPHIC CONSENT: I authorize Starlite Ballroom the photographic privilege of myself or my child if the child is a minor. I understand that my child's photograph may be taken by the representatives for Starlite Ballroom, event producers, sponsors, organizers, parents, and/or assigns. I agree that my or my child's photograph, including video photography, film photography, online Zoom recording, or other reproduction of my or my child's likeness, may be used without charge by Starlite Ballroom, event producers, sponsors, organizers and/or assigns for any purpose as they deem appropriate, including, but not limited to, promotional materials, fundraising presentations or proposals, newspaper or magazine publication or posting on a website for promotional purposes.

ELECTRONIC SIGNATURE AGREEMENT. By selecting the "I Accept" checkbox, I am signing this agreement electronically. I agree this electronic signature is the legal equivalent of my manual signature on this agreement. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

POLICIES Completion of Classes. Student agrees to complete all lessons and/or service(s) as expressly provided in student’s enrollment agreement. Student shall not be relieved of the obligation to make any payment agreed to, and no deduction or allowance for any payments shall be made by reason of student’s failure to use any lessons and/or service(s), except as provided in the student’s enrollment agreement. No Refunds. Tuition and class fees are non-refundable unless otherwise specified at the sole discretion of Starlite Ballroom. Dance Instruction. Starlite Ballroom shall provide its lessons, instruction and/or services in accordance with the Starlite method of dance instruction and shall make its facilities and personnel available for each lesson or service for such purposes during the term of dance instruction. Starlite Ballroom may provide the student with any instructor employed or contracted by Starlite Ballroom as it deems appropriate. Starlite Ballroom is not obligated to provide any specific instructor or to provide the same instructor for different lessons to students. Lessons are 45 minutes long, including transition time between lessons. Expiration of Lessons. Private lessons made available by Starlite Ballroom shall expire, whether actually used or not upon the agreed expiration date for all instruction or lessons, as set forth in a student’s dance enrollment agreement. All group lessons (if charged) shall expire over the same period as private lessons. The teaching/honoring of any lessons and/or services beyond the term of expiration shall not be deemed as a waiver of these provisions by the Starlite Ballroom. Assignment by Starlite Ballroom. Starlite Ballroom may assign a student enrollment agreement at its sole discretion and all monies due thereunder shall be paid directly to such third-party assignee upon notification. Non-Transferable by Student. A student’s rights under these policies are personal in nature and may not be sold, assigned, or transferred to any other person. In the event of a student’s death or physical disability, the student or his/her representative may sell, donate, or transfer the remaining lessons and/or service(s) to any persons or charity subject to Starlite Ballroom’s approval.

Arbitration. Any controversy, dispute or claim arising out of or relating to these policies or my dance lessons with Starlite Ballroom shall be settled solely by arbitration in accordance with the commercial arbitration rules of the American Arbitration Association and shall take place in the City of San Jose, California, USA. Judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction. All fees and expenses in connection with the arbitration shall be shared equally by the parties. Any action or arbitration must be fully brought within 12 months from the date the cause of action arises or within 6 months from the expiration of the student’s relationship with Starlite Ballroom, whichever occurs first. Governing Law. These policies and the enrollment agreement shall be governed and construed in accordance with the laws of California, excluding that state’s choice-of-law principles, and all claims relating to or arising out of these policies and the enrollment agreement or the breach thereof, whether sounding in contract, tort or otherwise, shall likewise be governed by the laws of California, excluding that state’s choice-of-law principles. LIMITATION OF LIABILITY. STARLITE BALLROOM EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. STARLITE BALLROOM'S LIABILITY ARISING OUT OF THESE POLICIES OR ANY ENROLLMENT AGREEMENT(S) SHALL BE LIMITED TO THE COMPENSATION PAID TO STARLITE BALLROOM AND IN NO EVENT SHALL STARLITE BALLROOM BE LIABLE IN ANY AMOUNT FOR ANY CONSEQUENTIAL, INCIDENTAL, INDIRECT OR SPECIAL DAMAGES, HOWEVER CAUSED AND ON ANY THEORY OF LIABILITY.

Personal Belongings. I am aware that I am responsible for the safekeeping of the belongings I bring to Starlite Ballroom, whether they are lost, stolen or left behind at Starlite Ballroom. If I leave something behind, I am aware that Starlite Ballroom is not liable for maintaining or retaining the item. Physical Ability and Fitness. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in dance classes, lessons or programs with and at Starlite Ballroom. I represent and warrant that I am fit and I have no medical condition(s) that would prevent my full participation in dance classes, lessons or programs with or at Starlite Ballroom. In consideration of being permitted to participate in dance and fitness classes, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I may incur as a result of participating in the classes. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that may incur, including death.

I understand that Starlite Ballroom and their instructors, officers, owners, employees, representatives and agents are acting in reliance on the preceding health statements in allowing my participation in dance lessons or other programs. Virtual Recording or In-Studio Recording. I understand and approve of the use of virtual recording or in-studio recording and photos which may be used for promotional purposes in print or online and used solely for Starlite Ballroom and I further agree that I am not entitled to any payment or renumeration for the use of my likeness or image in connection therewith by Starlite Ballroom or its owners, representatives and/or agents. Etiquette and Behavior. Starlite Ballroom strives to make all clients and students feel welcome and comfortable in its studios. Starlite Ballroom expects all students to extend the same welcoming spirit to one another and Starlite Ballroom staff and instructors. I agree to: • Go jewelry-free. Jewelry is potentially dangerous to me and others. • Respect other students and instructors and to wear deodorant, if possible. • Listen while my instructor is talking. • Turn off and stow away my cell phone. • Not to film or take pictures in class, unless instructed. • Pay attention at all times, especially when waiting for my turn and others around me to avoid unintended contact or injury. • Stay for the entire class, but if I must leave early, I will inform my teacher beforehand, and make my exit as quick and discreetly as possible. • No ins-and-outs. To avoid spread of COVID-19 and limit contact points, there will be no ins-and-outs during class. Doors will be closed when classes are in session and will remain closed during cleaning/sanitation period in-between classes. • Arrive on time. If I can’t avoid being late, I will enter very quietly and wait for the OK from your teacher to enter the dance floor. • Demonstrate good spatial awareness. Maintain physical distancing of six (6) feet minimum at all times, when possible. • Try your best. • Be courteous and respectful. • To help clean and sanitize my area after class. Gloves, disinfectant wipes, and hand sanitizers are provided and stationed around.

Severability. If any of the provisions of these policies are determined to be invalid, illegal, or unenforceable, such provisions shall be modified to the minimum extent necessary to make such provisions enforceable, and the validity, legality, and enforceability of the remaining provisions of these policies shall continue in full force and effect to the extent the economic benefits conferred upon the parties by the policies and dance lessons remain substantially unimpaired. Construction. The headings of these policies are for convenience only and are not to be considered in construing these policies. The language of these policies shall be construed according to its fair meaning and not strictly for or against any party.

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

Initials

Date

Thanks for submitting!

STARLITE BALLROOM

Call now for a FREE trial lesson*
408-252-7000

Best Dancing in San Jose

Class policies & Covid-19 Declaration