By checking the box below and submitting this form, I (“I,” “my,” or “me”) acknowledge and agree to the following Release of Liability and Assumption of Risk (“Release”) with Polina Glen LLC, a California limited liability company (“Polina Glen”). I understand that my electronic consent is legally binding and has the same force and effect as a handwritten signature under the Electronic Signatures in Global and National Commerce Act (ESIGN) and the Uniform Electronic Transactions Act (UETA).
The individual named below desires to participate in certain dance and/or performing arts instruction classes (the “Activity”) provided by Polina Glen. In consideration of the tangible value of a membership or access to Polina Glen’s studio and the intangible value that I will gain by participating in the Activity, and in recognition of Polina Glen’s reliance hereon, I agree, on behalf of myself, my heirs, and my personal representatives, to all the terms and conditions set forth in this Release.

Assumption of Risk
I am aware and understand that participation in the Activity is a potentially dangerous activity and involves the risk of personal or psychological injury, pain, suffering, temporary or permanent disability, death, property damage, and/or financial loss. I acknowledge that any injuries that I sustain may result from or be compounded by the actions, omissions, or negligence of Polina Glen, including negligent emergency response or rescue operations of Polina Glen. Notwithstanding the risk, I acknowledge that I am knowingly and voluntarily participating in the Activity with an express understanding of the danger involved and hereby agree to accept and assume any and all risks of injury, disability, death, or property damage arising from my participation in the Activity, whether caused by the ordinary negligence of Polina Glen or otherwise.

Waiver and Release
I hereby expressly waive and release any and all claims, liabilities, losses, demands, damages, lawsuits, judgments, settlements, fines, penalties and fees (including reasonable attorneys’ fees and court costs) (collectively, “Claims”) which I may have, or which I may hereafter have, whether known or unknown, against Polina Glen and its officers, directors, managers, employees, agents, affiliates, shareholders, successors, and assigns (collectively, “Releasees”), in connection with, arising out of or attributable to my presence at Polina Glen’s premises or my participation in the Activity, whether arising out of the ordinary negligence of Polina Glen or any Releasees or otherwise. I covenant not to make or bring any such Claim against Polina Glen or any other Releasee, and forever release and discharge Polina Glen and all other Releasees from liability under such Claims.

Insurance and Medical Responsibility
I understand that Polina Glen and the Releasees do not and will not carry any health insurance for participants, including myself, and that Polina Glen and the Releasees assume no financial responsibility for any of my medical, health, or disability payments. I affirmatively acknowledge that I do and will carry adequate insurance for my own health, medical, liability, property damage, disability, and death, and that my insurance shall provide primary and adequate insurance coverage for all Claims arising in connection with my participation in the Activity or presence at Polina Glen’s premises.

Equipment and Property
I am aware and understand that, in performance of the Activity, I may have access to Polina Glen’s equipment (the “Equipment”), and that I may supply my own equipment for use in the Activity. I hereby expressly waive and release any and all Claims on account of injury, disability, death, or property damage in connection with, arising out of or attributable to my use of the Equipment, or as a result of my use of my own equipment while on Polina Glen’s premises, or the negligence of any party, including Polina Glen or Releasees, whether passive or active. I hereby assume all responsibility for any damage I cause to the Equipment, and for any injury to persons as a result of my use of the Equipment or my own equipment.
I further expressly waive and release Polina Glen and the Releasees from all Claims for theft, loss of, or damage to, my personal property that was left at or carried in or on Polina Glen’s premises, whether or not the loss or damage was caused by Polina Glen’s negligence or was otherwise Polina Glen’s responsibility.

No Medical Advice
I acknowledge and agree that (a) Polina Glen does not engage in the practice of medicine and Polina Glen does not give medical advice, (b) the Activity, or any advice given in connection with the Activity, is not a substitute for professional medical advice, diagnosis, or treatment, and (c) I will always seek the advice of my healthcare provider for any questions regarding any medical condition.

Waiver of Unknown Claims (California Civil Code §1542)
I understand that by checking this box, I am waiving any and all claims, of any kind arising out of or attributable to my presence at Polina Glen’s premises or participation in the Activity, including those claims that may be unknown to me, or which I do not suspect to exist at this time. With the intention of waiving all unknown and unsuspected claims, I hereby expressly waive all rights, benefits, and protections I may have under California Civil Code section 1542, which reads as follows:
A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

Indemnification
I shall defend, indemnify, and hold harmless Polina Glen and all other Releasees against any and all Claims, the costs of enforcing any right to indemnification under this Release, the cost of pursuing any insurance providers, and other fees, arising out of or resulting from any Claim of a third party related to (i) my presence at Polina Glen’s premises, (ii) my participation in the Activity, (iii) my use of the Equipment, (iv) my use of my own equipment while on Polina Glen’s premises, and (v) my own negligence or the ordinary negligence of Polina Glen.

Terms of Service
In addition to the foregoing, I acknowledge that I have carefully read, fully understood, and accept all of the terms and conditions contained in Polina Glen’s Terms of Service, which have been provided to me separately.

Arbitration
I acknowledge and agree to give up any rights to litigate claims in a court or before a jury with respect to a claim. Further, I acknowledge and agree that other rights that I would have if I went to court may also be unavailable or may be limited in arbitration.
Except for disputes that qualify for small claims court, any claim, dispute, or controversy (whether in contract, tort, or otherwise, whether pre-existing, present, or future, and including statutory, consumer protection, common law, intentional tort, injunctive and equitable claims) between me and Polina Glen arising from or relating in any way to this Release, will be resolved exclusively and finally by binding arbitration. The arbitration will be administered by Judicial Arbitration and Mediation Services, Inc. (“JAMS”) in accordance with its Comprehensive Arbitration Rules and Procedures then in effect, except as modified in this Release. The Federal Arbitration Act will govern the interpretation and enforcement of this section. The arbitrator will have exclusive authority to resolve any dispute relating to arbitrability and/or enforceability of this arbitration provision, including any unconscionability challenge or any other challenge that the arbitration provision or the agreement is void, voidable, or otherwise invalid. The arbitrator will be empowered to grant whatever relief would be available in court under law or in equity. Any award of the arbitrator(s) will be final and binding on each of the parties and may be entered as a judgment in any court of competent jurisdiction. The arbitrator will conduct hearings, if any, by teleconference or videoconference, unless the arbitrator determines that an in-person hearing is appropriate. Any in-person appearances will be held in Los Angeles County, California, at a location reasonably convenient to me.

Notwithstanding the foregoing, nothing in this Release will preclude me from bringing issues to the attention of federal, state, or local agencies and, if the law allows, they can seek relief against Polina Glen for me. I understand and acknowledge that I may elect to pursue my claim in small claims court rather than arbitration if I provide Polina Glen with written notice of my intention to do so within sixty (60) days of the event giving rise to the claim. The arbitration or small-claims court proceeding will be limited solely to my individual dispute or controversy. I acknowledge and agree to arbitration on an individual basis. In any dispute, neither I nor Polina Glen will be entitled to join or consolidate claims by or against other third parties in court or arbitration or otherwise participate in any claim as a class representative, class member or in a private attorney general capacity. The arbitrator may not consolidate more than one person’s claims and may not otherwise preside over any form of a representative or class proceeding. The arbitrator has no power to consider the enforceability of this class arbitration waiver and any challenge to the class arbitration waiver may only be raised in a court of competent jurisdiction.

Governing Law and Jurisdiction
This Release constitutes the sole and entire agreement of Polina Glen and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is held invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. Polina Glen may assign this Release and its rights and obligations hereunder, in whole or in part, to any party. This Release is binding on and shall inure to the benefit of Polina Glen and me and our respective heirs, successors, and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule (whether of the State of California or any other jurisdiction). Each party irrevocably submits to the exclusive jurisdiction of the federal or state courts sitting in Los Angeles County, California, for the purpose of any suit, action, or other proceeding arising under this Agreement that is deemed non-arbitrable by a court of competent jurisdiction. I hereby irrevocably and unconditionally: (a) consent and submit to the exclusive jurisdiction of the aforementioned courts; and (b) waive any objection to that choice of forum based on venue or to the effect that the forum is not convenient.

Final Acknowledgement
By checking the box below, I acknowledge that I have carefully read and fully understood all of the terms of this Release and that I am voluntarily giving up substantial legal rights, including the right to sue Polina Glen for claims, whether known or unknown, arising out of the Activity. I represent and warrant that I am at least eighteen (18) years of age, fully competent, and have the full right, power, and authority to enter into this Release.