Online Registration Form

Online Registration Form

Media Release Agreement Form
Waiver and Release of Liability Form

"*" indicates required fields

Urban Swing Dance Institute (USDI) L3C

Online Registration Form

By signing this form, you consent and agree to receive class related information via text and email, and pay for the course, in full, in advance, at the payment cycle(s) below. (You will not be able to participate in classes until payment is received. No exceptions. No refunds.) The birthday information is requested to recognize and honor your special day with other students who share the same birth month. You also agree to be respectful and mindful of all instructors and students and follow all rules and instructions.

Dance classes, like any other form of instruction, require commitment, self-discipline, practice, and participation for success. It is a process and a journey. We want everyone to enjoy the experience and have fun, but keep in mind our primary goal is to learn how to dance. We provide the knowledge and skills in the classroom. This is where the work is done. (You do not learn how to dance in the classroom.) The dance floor is the lab. This is where you apply and develop the knowledge and skills from class. It is where we have fun. (This is why it is important that you participate in as many out of class dance opportunities as possible.) Please be patient. Don’t worry about making mistakes or messing up. (Many moves are discovered or created from mistakes.) This is how we learn. No one gets it right on the first try. This is a social dance class. It is not a competitive or professional dance class. No pressure. No worries. Enjoy the process and the journey. Looking forward to meeting you in class!!!

Print Name*
Address*
MM slash DD slash YYYY
Experience Level*

Payment


Step 1. Visit this Paypal Link to process your payment "paypal.me/WDSNOLA".
Step 2. Once successfully process the payment, make sure to take a " SCREENSHOT " for your proof of payment.
Step 3. Go back in this form and upload the screenshot below for your proof of payment.

Max. file size: 100 MB.
Upload the screenshot here as a proof of your payment in Paypal.
Payment Cycle*
Max. file size: 100 MB.
Upload a file signature as a consent of this Waiver and Release Liability Form.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

"*" indicates required fields

Media Release Agreement
Louisiana

MM slash DD slash YYYY

The party listed above will refer to themselves throughout this document as "the Releasor," "I," and through the use of other first-person pronouns.

I, the Releasor, hereby and irrevocably consent to the use, publication, distribution, broadcasting, reproduction, live-streaming, editing, recording, posting, copyrighting, licensing, digitization, and/or re-release of the Released Media, as defined below, by the following company, as well as any employees, affiliates, associates, representatives, or agents (collectively referred to as the "Release Receiver") for any legal reason or purpose, including but not limited to social media, commercial products, education, course materials, video footage, sales, marketing, or any other medium in any form that has been or will be invented:

Who Dat Steppers of New Orleans LA LLC, dba Urban Swing Dance Institute, L3C, a limited liability company, organized under the laws of the state of Louisiana, having its principal place of business at the following address:

1561 N. Dorgenois St., New Orleans, LA 70119

The media being released on or from the following medium:

Any medium (newspapers, radio, television, or internet) created while participating in any class or event in relation to, or association with, the Urban Swing Dance Institute, L3C.

The Released Media may be in any one or more of the following formats: video, audio, photographic, digital/analog, streaming.

I agree that this consent is realized and enforceable as of the Effective Date listed at the head of this document.

I hereby release the Release Receiver from any and all claims and demands arising out of or in connection with any use of the Released Media, including, without limitation, claims for privacy violations, right of publicity claims, defamation and/or any other intellectual property rights. I claim no ownership of the Released Media and forgo any opportunity, whether past or present, to copyright or trademark the Released Media.

I give consent to the use of this Released Media while knowing and understanding that my name, comments, and other identifying factors may be revealed to the general public. However, the Release Receiver may not make known to any party in any medium my known or previously known location, email or physical address, or any other contact details, such as my phone number.

I am over eighteen years of age and have full legal rights and authority to consent to the terms of this Media Release Agreement:

Consent*
This field is for validation purposes and should be left unchanged.

"*" indicates required fields

WAIVER AND RELEASE OF LIABILITY

IN CONSIDERATION OF the risk of injury that exists while participating in SWING DANCE CLASS (hereinafter the "Activity"); and

IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge URBAN SWING DANCE INSTITUTE, located at 1561 N Dorgenois St, New Orleans, Louisiana 70119, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Urban Swing Dance Institute to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Urban Swing Dance Institute official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Urban Swing Dance Institute AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Urban Swing Dance Institute FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Urban Swing Dance Institute, its agents, and employees.

I agree that this Release shall be governed for all purposes by Louisiana law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both _________________ Participant, and Urban Swing Dance Institute agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

In the event of an emergency, please contact the following person(s) in the order presented:

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.

PARENT / GUARDIAN WAIVER FOR MINORS

In the event that the participant is under the age of consent ( 18 years of age), then this release must be signed by a parent or guardian, as follows:

I HEREBY CERTIFY that I am the parent of

named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Max. file size: 100 MB.
Upload a file signature as a consent of this Waiver and Release Liability Form.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.