HarmsaStar Liability Waiver and Consent Form:

*THIS FORM MUST BE COMPLETED IN ORDER TO PARTICIPATE IN ANY CLASS OR WORKSHOP

I, being above age 18 or having the consent and approval of my parent or legal guardian, 

agree as follows: As a participant in any program or class offered by HarmsaStar, I 

recognize and acknowledge there are certain risks of physical injury. I acknowledge and 

understand that attending, participating, or assisting someone to participate in any of the 

programs or classes offered may involve strenuous physical exertion, require a significant 

degree of skill and experience, and could be physically hazardous or dangerous. I hereby 

represent and warrant that I have the physical ability and skill necessary to participate in 

the classes or other programs offered by HarmsaStar and do not have any limitation, 

condition, or problem which would inhibit my ability to participate properly and safely. I 

agree to assume the full risk of injuries, including death, damages, or loss that I or my 

minor child may sustain as a result of participating in any activities connected with or 

associated with such program or class offered by HarmsaStar. I agree to waive and 

relinquish all claims I or my minor child may have as a result of participating in any 

program or class against HarmsaStar and its officers, agents, servants, employees, 

volunteers, and independent contractors. I further agree to indemnify and hold harmless 

and defend HarmsaStar and its officers, agents, servants, employees, volunteers, 

and independent contractors from my claims resulting from injuries, including death, 

damages, and losses sustained by me or my minor child that arise out of, in connection 

with, or are in any way associated with the activities involved with the programs or classes 

offered by HarmsaStar. I also understand that HarmsaStar promotes dance and yoga as 

an art form not only to its students, but also to the community at large. As such, articles, 

brochures, videos, and web sites may be used promotionally and may include images of 

HarmsaStar students or other participants in our programs. I hereby permit the use 

of my, or my daughter/son’s image to be photographed, videotaped, or otherwise recorded 

for use in HarmsaStar's promotional materials. These materials include, but are not 

limited to, photographs and videos of classes and performances, newsletters and other 

promotional materials, and internet web pages.

Printed name:

Signed:

Date: