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Class Liability Waiver and Disclaimer

Please read fully the following document before beginning class. Printed copies of this form and the Signature page are available at the studio.

Bashirah Fusion Belly dance Class Student Participation Waiver and Liability Release

I choose to participate in classes, performances, workshops, and/or other activities hosted by Bashirah Fusion Bellydance of my own free will and certify that I am in proper physical condition to take part in such activities.

If I have questions about whether an activity is suitable for me to pursue, I will consult my health care provider in making that decision. If I have any known physical vulnerabilities, conditions, or injuries, I agree to discuss them with Bashirah before participating


By signing this document, I release Bashirah Fusion Bellydance and her students, studio staff, employees, volunteers, associates from any liability or claim that I or my representatives may have against Bashirah Fusion Bellydance with respect to any bodily injury, personal injury, illness, death, or property loss or damage that may result from my participation.

I voluntarily release and forever discharge and hold harmless Bashirah Fusion Bellydance from any and all claims or demands for damages, loss of services, costs and expenses, injuries, attorney fees, and any other call for reparation from any and all injury to me or my property arising in any way from my participation in dance classes, camps, intensives, workshops, performances, troupes, the use of equipment or facilities, and any activities associated with Bashirah Fusion Bellydance


I understand that there are risks of physical injury associated with, arising out of, and inherent to dancing. These risks include the potential for slips and falls, sprains, strains, dislocations, soft tissue injuries, musculoskeletal injuries, podiatric conditions, and other risks not specified here.

Understanding these risks and the potential for others not listed, I agree to personally accept and assume all of the risks present in my participation in any and all Bashirah Fusion Bellydance events. My participation is entirely voluntary, and I choose to participate in spite of the risks.

Dance education sometimes requires hands-on instruction as well as verbal instruction. Instructors may correct dancers by touching their arms, legs, feet, hips, back and head to move them in the correct position. I acknowledge that this is a common standard in dance instruction and understand that it is my responsibility to communicate clearly with my teacher if any form of touch is unacceptable to me.

Medical Treatment and Insurance

I understand that Bashirah Fusion Bellydance does not assume any responsibility for or obligation to provide financial or other assistance in the event of injury or illness, including but not limited to medical, health, or disability insurance or support.

I authorize Bashirah Fusion Bellydance to obtain necessary medical or dental treatment, including first aid, ambulance transport, hospitalization, or such other care necessary for my health and welfare in an emergency. If my insurance does not cover emergency treatment that is deemed necessary and sought for me by Bashirah Fusion Bellydance, I agree to be responsible for and pay all costs incurred on my behalf.

I release and discharge Bashirah Fusion Bellydance from any claim which may arise on account of any first aid, treatment, or service rendered in connection with my participation in activities or with the decision by any representative or agent of Bashirah Fusion Bellydance to consent to medical or dental treatment on my behalf in an emergency.

I understand that Bashirah Fusion Bellydance does not carry or maintain health, medical, dental, or disability insurance coverage for any participant. I agree to take responsibility for full payment of any emergency medical or dental costs related to my participation regardless of whether I have insurance coverage.

Photographic Release

I understand that Bashirah Fusion Bellydance may take photo and video recordings of me during my participation in classes and activities. I convey to Bashirah Fusion Bellydance full rights and interest in these recordings. I understand such recordings may be used in advertising or other published materials, physical or virtual.

If I do NOT consent to being photographed or video-recorded, I will make sure the teacher is aware of my concerns and the reasons for them, I will be proactive about avoiding being photographed or recorded, and I will hold Bashirah Fusion Bellydance harmless if a photo or video recording of me is released despite all precautions. I understand that this choice may limit my participation in classes, workshops and performances that are routinely photographed and/or videotaped.


While a participant at Bashirah Fusion Bellydance events, I agree to abide by any rules, codes, and policies that are put in place before or at any time during my participation. If I have questions or concerns regarding any policies or decisions made, I agree to bring them promptly and specifically to the teacher’s attention.

If I file a lawsuit against Bashirah Fusion Bellydance, I agree to do so solely in the state of New Hampshire and agree that the substantive law of New Hampshire shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect


All participants must sign the Signature Page (available at the studio) at the start of each dance year certifying that they have read this document, understand it in its entirety, and agree to be bound by its terms, before participating in classes.





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