Liability Waiver for Tracy Rhaj and The Premises

The Yoga and Dance Co

Last Updated on June 27th, 2024

Important Note:
This is a sample copy of the printed document, just for your review.
Before starting your first in-person belly dance class with Tracy Rhaj in Southern California, you will be provided with a printed copy for the corresponding studio you attend to for you to sign in person.


Please read this document, which includes the Liability Waiver, Code of Conduct, Terms and Conditions, plus Privacy Policy for the instructor (whose artistic name is Tracy Rhaj and Legal Name is Treisi Andrea Ramirez Gonzalez) and The Yoga Dance Co. (The Premises). After having read the document, please fill out and sign the form on page 4. You will receive your scanned copy by email.


In consideration of the services of the instructor Tracy Rhaj (Treisi Andrea Ramirez Gonzalez), The Premises, their agents, owners, officers, volunteers, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "The Premises"), I hereby agree to release, indemnify, and discharge Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and the The Premises, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows: I understand that belly dance, dance in general, yoga, aerial yoga, fitness, TRX, gymnastics, tumbling, and aerial arts (acrobatics) includes physical movements, as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious, disabling or even death, is always present and cannot be entirely eliminated.


If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages, which may incur through participation. Belly dance, yoga, dance, aerial yoga, fitness, TRX, gymnastics, tumbling, and aerial arts (acrobatics) is not a substitute for medical attention, examination, diagnosis or treatment. Belly dance, yoga, dance, aerial yoga, fitness, TRX, gymnastics, tumbling, and aerial arts (acrobatics) is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program.


In addition, I will make the instructor aware of any medical conditions or physical limitations before class and I shall discontinue any movement if it feels uncomfortable. If I am pregnant, become pregnant, or I am post natal or post-surgical, my signature verifies that I have my physician’s approval to participate. I also affirm that I alone am responsible to decide whether to practice belly dance, yoga, dance, aerial yoga, fitness or acrobatics and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Tracy Rhaj (Treisi Andrea Ramirez Gonzalez), The Premises, its owners, officers, employees, and instructors.


I acknowledge that my participation in belly dance, yoga, dance, aerial yoga, fitness, TRX, gymnastics, tumbling, and aerial arts (acrobatics) activities, including but not limited to aerial arts instruction, aerial silks, aerial lyra (hoop), aerial trapeze, aerial hammock, aerial swing and circus training and instruction activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: slips and falls; falling from equipment; rope burns, pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; strains, cuts, muscle soreness and fractures, broken bones; musculoskeletal injuries including head, neck, and back; nerve damage; injuries to internal organs; the negligence of other participants or persons who may be present; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with this activity.

Traveling to and from shows, meets and exhibitions will raise the possibility of any manner of transportation accidents. In any event, if you or your child is injured, any medical assistance will be at your own expense. Furthermore, Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises personnel have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.


I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The The Premises from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of The Premises’ equipment or facilities, including any such claims which allege negligent acts or omissions of Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) or The Premises. Should Tracy Rhaj (Treisi Andrea Ramirez Gonzalez),  The Premises, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. In the event that I file a lawsuit against Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) or The Premises, I agree to do so solely in the state of California, and I further agree that the substantive law of that state 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.


I hereby grant and authorize Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or videos taken of me and/or my child to be used in and/or for any lawful promotional materials including, but not limited to, newsletter, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media formats and markets now known or later discovered. This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing. I waive the right to inspect or approve any finished product in which my likeness appears, including written or electronic copy.

I agree that I have been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the photographs or videos. I understand and agree that these materials shall become the property of Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises and will not be returned. I hereby hold harmless and release Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises from all liability, petitions, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.


By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) or  The Premises on the basis of any claim from which I have released them herein.


I also agree that this document is valid for subsequent visits and participation at The Premises for belly dance classes with Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) or any other classes. I have had sufficient opportunity to read this entire document.


I have read and understood it, and I agree to be bound by its terms. I hereby declare that I am in good physical condition and have no medical conditions or injuries that would prevent my safe participation in fusion belly dance classes. If I have any health concerns, I will consult with my healthcare provider before participating. I agree to follow the instructions and guidance provided by the instructor during the classes. I will inform the instructor of any discomfort, pain, or limitations I may experience during the class.

I acknowledge that I am responsible for my personal belongings and any equipment I bring to the classes.

Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises are not responsible for any loss or damage to my personal property. I agree to comply with all the policies and rules set forth by Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises for the safety and well-being of all participants. In the event of a medical emergency, I authorize Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) and The Premises to seek emergency medical treatment on my behalf.


I have read this liability waiver and fully understand its terms. I voluntarily and knowingly agree to its contents. I am aware that by signing this waiver, I am giving up certain legal rights.

Code of Conduct to provide a pleasant and safe environment to everyone:

  • Please be respectful to your teacher at all times.
  • Please be respectful to all of your class peers at all times.
  • Do not interrupt the class and follow directions accordingly. There will be opportunities to ask questions.
  • Please silence your cell phone(s) during the class to avoid any interruptions or distractions.

Terms and Conditions:

Address and time:

Tracy Rhaj (Treisi Andrea Ramirez Gonzalez)’ belly dance classes take place on Fridays at 7 pm at The Yoga Dance Co.
Weekly Classes are 1 hour long.


Please make sure that your class fee is covered by the end of each class at the latest. Should you forget to make a payment, you will receive friendly reminders. Thanks for understanding!
*Fees are subject to change in the future. If that were the case, you will get notified at least 45 days in advance.

Payment Options:

Cash, Zelle or Venmo.


The 4-Class Package expires within 60 days. You have 2 months to take your 4 classes, although I highly recommend you attend every week to have faster progress, build a large dance repertoire, and discipline.

  • Please note that all sales are final; there are no refunds. You may transfer your fee to online classes, reschedule attendance if you happen to have an emergency, or even transfer to someone else.
  • You will receive a welcome email, including a scanned copy of page 4 after being filled out.
  • You will receive a confirmation email, acting as a payment receipt, only after each purchased package.
  • Additionally, you will receive a card, postcard size, to keep track of your payments and attendance. Please verify it is up to date and inform your instructor if it needs to be updated.

Classes’ Curriculum:

Belly dance is very versatile! Besides the universal moves, concepts, combos, music, and costuming, we will also dive into fusion belly dance, and Fat Chance Belly Dance concepts too! The instructor’s dance training ranges in different types of belly dance and even different types of dances. Full details on her website at


Class Attire:

Students shall wear appropriate attire, such as comfortable lycra or sports clothing, and either ballet slippers, socks, or no shoes, in order to not damage the floor and to dance comfortably. Yoga mat is recommended.

Contact Information:, facebook messenger, instagram dm

Privacy Policy:

Your personal details will not be shared or sold to any company. Tracy Rhaj (Treisi Andrea Ramirez Gonzalez) maintains a record of your information for bookkeeping, taxing purposes, attendance, and to keep in touch whenever necessary, plus occasional email promotions, should you agree to opt in. Full details at


After having read the previously mentioned statements in pages 1 through 3, please fill out the following required fields. Please let us know if you have any questions beforehand.
You will receive a scanned copy by email.


First Name: ___________________  Middle Name:  __________________  Last Name: _________________

Email: _______________________________________

____ Please check here if you agree to receive occasional promotional emails from Tracy Rhaj, which you can unsubscribe from at any time. 

Cell Phone: ________________________________________________

Full Address: ___________________________________________________________________________

Student’s Birthday:  (Month): _______________ (Day):___________________ (Year):_________________

Student’s Full Name Parent or Guardian (only if student is a minor): ___________________________________

Your Facebook Profile (if you would like to be added to Tracy Students’ private facebook group):



____ Please check here if you have fully read, agreed, and understood this document, which includes legal statements, a Liability Waiver, Code of Conduct, Terms and Conditions, and Privacy Policy.


I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of California.


Signature: ____________________________________   Date: ________________________________________

For any questions, please to reach Tracy at:
Facebook and Instagram: @TracyRhaj 

By enrolling in Tracy Rhaj’s in-person or online Fusion Belly Dance classes and workshops, you acknowledge that you have read, understood, and agreed to abide by her:
terms and conditions, privacy policy and legal disclaimer. If you have any questions or concerns, plase send an email to for clarification.

Thank you for choosing me as an instructor for your dance journey. Let's dance, have fun, and celebrate the joy of movement together!


Tracy Rhaj (Treisi Andrea Ramirez Gonzalez)

(Para español, por favor utiliza el botón traductor en la parte arriba a la derecha de la página).


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