Dance with Shaadi

Live To Dance Inc

Since Jul 2013

                     Yalda Night's IGSF Performance on Dec 3th,2016

                          Performing  by Live to Dance Zumba Crew

                                  Mehregan Event on Oct 11th,2015

                  Performing by Live to Dacne Hip-Hop/Zumba Crew

                                  Free Zumba Event 2015

Please print & fill this Waiver Liability &bring it with you on the day of event! Thank you

Liability Waiver

1. I, _______________________________the undersigned participant in this Zumba Fitness class, as a condition of my participation, hereby waive any and all claims I may have now or in the future against my instructor,

SHADI MESDAGHI in connection with or arising out of my participation with this Zumba

class or any injury to myself related hereto.I recognize that Zumba requires physical exertion,

which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my

participation in the Zumba classe. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Zumba Classe or Workshop.

3. In consideration of being permitted to participate in the Zumba Classe or Workshop, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which might incur as a result of participating in the program.

I have read the above Release and Waiver of Liability and fully understand it’s contents. I voluntarily agree to the terms and conditions stated above.

First name ____________________ Last name_______________________

Age: ___________________________________________ (Zumba event) Dec 19th,2015

Signed Date

_____________________________________ _________________________________

Phone Number Email

Event's location : Hoopsplus facility located on 45496 Ruritan circle, Sterling,VA

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