Babywearing Dance Class Waiver & Release of Liability
Instructor: Zoe Ressler
Business Name: Babywearing Dance Portland LLC
Location: The Viscount Dance Studio
This waiver must be completed and signed by all adult participants. For children (including infants and toddlers worn in class), the parent or legal guardian must sign on their behalf.
Description of of Activities & Associated Risks
Babywearing Dance is a group movement class involving dance and exercise while wearing an infant in a soft-structured baby carrier. Activities may include:
● Repetitive motion
● Dynamic balance shifts
● Bending, swaying, or twisting
● Cardio movement in a group setting
● Core exercises on the ground
These activities carry inherent risks, including but not limited to:
● Falls or loss of balance
● Overexertion or joint/muscle strain
● Aggravation of postpartum injuries or pelvic floor issues
● Pregnancy complications
● Improper use of baby carriers
● Infant injury due to movement, positioning,inadequate support, or sudden shiftsuì
● Emotional distress or fatigue Illness due to group indoor activity
Assumption of Risk
● I understand and voluntarily assume all risks associated with participation in Babywearing Dance for both myself and my child(ren), including those that may result in personal injury, illness, permanent disability, or death. These risks may arise from my own actions, those of others in the class, or from the environment.
● I acknowledge that Zoe Ressler, the instructor, is not a certified fitness instructor, dance instructor, physical therapist, or babywearing specialist. I acknowledge that she is a licensed speech language pathologist but is not acting in that capacity during this class. She is not offering medical care,therapy, or clinical services in any form.
● Class instruction and participation is not a substitute for medical advice, physical therapy, fitness training, or babywearing safety consultation. Participants are encouraged to consult with their own healthcare providers prior to participating, particularly if they are pregnant, postpartum, recovering from injury, or managing any physical condition.
● I acknowledge the specific risks associated with dancing while babywearing, and I am aware that no guarantees of safety can be made.
Medical Acknowledgment and Pre-class Safety
I confirm that:
● I have been medically cleared to resume babywearing cardio dance while pregnant or following pregnancy and birth (if applicable).
● I am currently not under any medical restrictions that would prohibit participation in babywearing cardio dance.
● My baby is healthy, has been born at least 8 weeks ago (corrected as necessary), weighs at least 7 lbs, and has sufficient neck/head control. If my baby is 3 months old or younger, I agree to support their head with one hand at all times and to abstain from any arm movements demonstrated by the instructor that do not allow for continuous head support.
● I am using a safe, ergonomically appropriate carrier, and I understand how to adjust and fit it safely based on babywearing guidelines:
• Visible & kissable face
• Legs in “M” or frog-leg position
• Regular baby checks throughout class, including during movement
● I am solely responsible for checking the carrier’s fit, condition, and safety before class
● If I am pregnant, I have consulted with my healthcare provider and am aware of the risks.
I accept full responsibility for any injuries or health issues that may arise in myself or my child during or after class participation and I agree to monitor my physical condition and my baby’s safety throughout class, and to stop activity if I feel unwell or unsafe.
Release & Hold Harmless Agreement
In consideration of participation in this activity, I, on behalf of myself and my child(ren), hereby release, waive, discharge, and agree to hold harmless:
● Zoe Ressler
● Babywearing Dance Portland LLC
● The Viscount Dance Studio
● Any associated instructors, volunteers, or agents
from any and all liability,claims,demands,causes of action, or damages arising out of or related to any loss, injury, disability, illness, or death that may be sustained by me or by my child while participating in the class.
This release applies to injuries sustained by the adult participant and/or the child in the carrier, regardless of cause,including negligent acts or omissions.
Media & Photography Release (Optional)
I grant permission for Zoe and Babywearing Dance Portland LLC to photograph, videotape, or otherwise record me and/or my child during class. These images may be used for promotional purposes including, but not limited to:
● Social media, website, email newsletters, printed marketing
I understand I will not receive compensation and waive any rights to review or approve final media.
☐ Check here if you DO NOT consent to photo/video usage.
I will also notify the instructor in writing if I do not consent.
Child Participation & Proxy Consent
I confirm that the child(ren) listed below will be participating in this Babywearing Dance class. I understand that:
● If I am the parent or legal guardian, I consent to their participation and assume all associated risks.
● If I am not the parent or legal guardian, I certify that I have been given express permission by the parent/legal guardian to attend and participate in this class while babywearing their child.
● I acknowledge that I am responsible for the child’s safety and well-being during the class, including correct use of the baby carrier.
● I understand that all terms of this waiver—including assumption of risk, medical acknowledgment, and media release—apply to the participating child(ren) as well.
Severability & Governing Law
If any provision of this waiver is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect. This agreement shall be governed by the laws of the State of Oregon.
Participant Acknowledgment & Signature
By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms of this waiver and agree to be bound by its terms in full. I accept full responsibility for my participation and that of my child(ren), and I understand this waiver is in addition to any waiver required by The Viscount Dance Studio and does not supersede or conflict with their terms.
Participant Full Name (Adult): _________________________________________
☐ I am the parent or legal guardian
☐ I am NOT the parent/legal guardian, but I have permission from them to babywear and participate with their child(ren) in this class.
If I am not the parent/guardian, I confirm they are aware of class risks and logistics and agree to provide contact info for the legal guardian upon request.
Signature: _____________________ Date:____________________________
Child(ren) Name(s) and Age(s): ________________________________________
Optional
Phone Number:________________________________
How Did You Hear About Us: ___________________________
Emergency Contact Name and Phone: ___________________________________