WAIVER & RELEASE FORM
PLEASE READ THE ENTIRE AGREEMENT PRIOR TO SIGNATURE/S
Upon checking in, please let us know any and all medical conditions and/or injuries you have or have had in the past that might impact your ability to participate in any strenuous activities.
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
In consideration of the services of Moksha Aerial Studio, Inc. (MASC) their agents, directors, officers, volunteers, participants, employees, independent contractors, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "MASC"), I hereby agree to release, indemnify, and discharge MASC, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:
I acknowledge that my participation in circus skills, dance, aerial arts, acrobatics, gymnastics, yoga and/or any other instructional clinic 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: aerial and circus activities involve certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Without a certain degree of risk, students would not improve their skills, and the enjoyment of the activity would be diminished. Training exposes its participants to the usual risk of cuts and bruises. Other more serious risks exist as well. Participants can fall, sustain sprains and strains, and can suffer more serious injuries as well. Traveling to and from events and classes raises the possibility of any manner of transportation accidents. In any event, if you or your child is injured, you or your child may require medical assistance, at your own expense.
Furthermore, MASC contracted instructors 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 may give incomplete warnings or instructions, and the equipment being used might malfunction.
2. 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.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless MASC 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 MASC equipment or facilities, including any such claims which allege negligent acts or omissions of MASC.
4. Should MASC 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.
5. 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.
6. In the event that I file a lawsuit against MASC, I agree to do so solely in the state of Montana, and I further agree that the substantive law of Montana 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.
This confirms that I have agreed to be videotaped and/or photographed by MASC and that MASC will own any and all photo/video rights of me for use in future media. MASC shall be the sole and exclusive owner of all media and of all of the results and proceeds of my appearance. Any published work performed in accordance with this Agreement shall be the exclusive property of MASC.
This release will permit MASC to proceed with the said video/photography recording and/or usage of the said video/photography recording; and I hereby waive to MASC possession of all media currently known and unknown, in all universes, and in perpetuity, all personal right and objection to any use to be made of me, my name or my personality in connection with the use of said video/photography containing my image, and/or voice recording for any and all media presentations, publicity and for any other trade and advertising purposes or publications.I understand that in proceeding with the said video/photography, MASC will do so in full reliance on the foregoing permission. I understand that I will not receive compensation for my participation.
By signing this document you may be waiving your legal right to a jury trial to hold the provider legally responsible for any injuries or damages resulting from risks inherent in the sport or recreational opportunity or for any injuries or damages you may suffer due to the provider’s ordinary negligence that are the result of the provider’s failure to exercise reasonable care.
Birthdate: _______________________________ (must be at least 18 years of age, OR parent/guardian must sign)