In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, by checking the box below I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to:

• Waive, release and discharge from any and all liability DanceOut Fitness LLC and all venues where classes are held, their elected and appointed officials, contractors, employees, students, agents, and volunteers for my death, disability, personal injury, property damage, or property theft, or actions of any kind which may hereafter accrue to me. I understand that Queen City DanceOut is in no way responsible for the safekeeping of my personal belongings while I attend class.Indemnify and hold harmless all Queen City DanceOut host venues where classes are held, their elected and appointed officials, employees, students, agents, and volunteers from any and all liabilities or claims including both personal injury and damage to property made by other individuals or entities as a result of or relating to my participation in this activity. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.

• I know that there may be risks associated with fitness classes and willingly accept those possibilities. I hereby represent to Queen City DanceOut that I have sufficient knowledge, expertise and physical condition to participate in any such activities engaged in by me and I am relying on my own judgment and investigation as to the safety of such activities. I understand that classes at may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss or death. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the fitness class and, to the extent I deem advisable, will consult a physician before participating in any of the activities. I agree to pay all reasonable costs related to the classes, including any medical costs I incur.

I hereby give my consent and permission to DanceOut Fitness, LLC and its affiliates, sponsors and corporate sponsors, successors, licensees, and assigns the irrevocable rights to use for any purposes whatsoever and without compensation, (i) any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of classes or events. Use of any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this class or event are at the sole discretion of DanceOut Fitness, LLC. Your likeness may be used at any time to advertise or benefit DanceOut Fitness, LLC and may be used on the web, any social networking site or in person.

Therefore, intending to be bound and as a condition of being allowed to participate in the fitness class, I have freely agreed to this waiver on the date indicated.