Zumba® Kids at P.S. 77 Lower Lab School Child’s Full Name: _____________________________________________________________

Date of Birth: _________/_________ /_________

Please list and describe anything that could negatively affect your child’s class experience

(a disability, injury, allergies, asthma, recent illness, etc.)__________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Parent Consent and Liability Waiver As parent/guardian, I give my consent for my child to participate in the Zumba® Kids program at

P.S. 77 Lower Lab School. I recognize the risks of injury common to any fitness program. I hereby waive and release Zumba® Fitness, the Zumba® Kids Fitness Instructors, Training Concepts, LLC, and volunteers and employees from any and against all claims of liability for any accidental injury or illness which may incur as a result of participating in the said fitness program including accidents or injury while on or about their premises, or while on off-site performances or activities. I hereby assume all risks connected therewith and consent my child to participate in said program.

In the event of any emergency, I authorize medical attention from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my child’s immediate care and agree that I will be responsible for payment of any and all medical services rendered. It must be noted that the absence of health insurance coverage does not make Zumba® Fitness, the Zumba® Kids Fitness Instructors, or Training Concepts, LLC to be automatically responsible for payment of medical expenses.

This acknowledgement of Risk and Waiver of Liability has been read, understood completely and signed voluntarily by the parent/legal guardian of named student.

Further, I give my permission for Training Concepts, LLC to use photos and videos of my child (no last names will be used without express permission) on print and website promotional materials. Said photos and videos will be used appropriately and solely for the marketing of Zumba® Kids Jr., online or in printed materials.

______________________________________________ _________________________ Parent/Guardian (signature) Date

______________________________________________ Parent/Guardian (print)

What is The Zumba® Kids Program?

Zumba® Kids Jr. and Zumba® Kids classes are designed exclusively for kids (ages 4-6 and 7-11, respectively) to combine movement, music and community in a class for children. These classes are rockin’, high-energy dance parties packed with specially choreographed, kid-friendly routines and all the music kids love, like hip-hop, reggaeton, cumbia and more. Zumba® Kids and Zumba® Kids Jr. inspire kids to express themselves through movement and play while effectively improving their overall health and well being. Kids love it because it’s on the cutting edge and fun, and parents love it because it’s active, fun, and for the effects it has on kids – increasing their focus and self-confidence, boosting metabolism, and enhancing coordination. While physical activity is indeed a very important element of childhood development, Zumba® Kids also considers other facets of the child’s development including:

• Leadership • Respect • Teamwork • Pride, Confidence and Self Esteem • Memory and Sequencing • Creativity and Imagination • Coordination and Balance • Spatial Awareness