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Madison Circus Space Liability Waiver

ACKNOWLEDGEMENT OF RISK, WAIVER AND RELEASE OF CLAIMS

PLEASE READ THIS ACKNOWLEDGMENT OF RISK, WAIVER, AND RELEASE OF CLAIMS (THIS RELEASE)
CAREFULLY. BY SIGNING THIS RELEASE, YOU WILL GIVE UP CERTAIN LEGAL RIGHTS. IF YOU DO NOT
UNDERSTAND ANYTHING IN THIS RELEASE, YOU SHOULD SEEK THE ADVICE OF YOUR LEGAL COUNSEL BEFORE
SIGNING BELOW. The undersigned (you) agrees that when present in the facilities of Madison Circus Space, Inc. a Wisconsin
nonstock corporation (MCS). You hereby agree to the following:

Acknowledgement of Risk. You acknowledge there is an inherent risk in the use of props and equipment located in the facilities
of MCS (collectively, the "Equipment"). You further acknowledge that such risk includes, but is not limited to physical
injury, illness, death, or damage to personal property. You acknowledge that the risks inherent in the use of the "Equipment"
are always present and that such risks are increased when the "Equipment" is used incorrectly or unsafely. You represent and
warrant to MCS that you have all of the necessary and proper training and knowledge for any and all uses (collectively "Your
Use") of the "Equipment" and that you will never intentionally engage in unsafe or improper use of said "Equipment". Your
Use will be in accordance with any and all rules, guidance and protocols set forth by MCS. You assume all risk of any injury,
damage or loss. This Release applies to all use of the "Equipment" regardless of your authorization for such use.

I Agree

Waiver and Release Claims. You waive, relinquish, discharge, release, and covenant not to sue MCS, or any of its affiliates,
owners, directors, managers, officers, employees, representatives, representatives, board members, agents, assigns or insurers
(collectively, the Waived Parties), from any and all rights, claims, demands, causes of action, damages, liabilities or losses,
that you, your employer, your assigns, your family members or kin may have or could have had that may arise from or are
related to "Your Use" (INCLUDING NEGLIGENCE BUT NOT INTENTIONAL OR RECKLESS MISCONDUCT BY A
WAIVED PARTY).

I Agree

Disclaimer of Liability. In no event shall any waived party be liable for any direct, indirect, incidental, special, exemplary,
punitive or consequential damages, however caused and on any theory of liability, whether, of liability, whether in contract,
strict liability of tort (INCLUDING NEGLIGENCE BUT NOT INTENTIONAL OR RECKLESS MISCONDUCT BY A
WAIVER PARTY) arising in any way out of Your Use, even if such Waived Party has been advised of the possibility of
such damage. This disclaimer of liability applies to any damages, injuries or losses including, without limitation, personal
injury, death or property damage, under any cause of action.

I Agree

I hereby grant the Madison Circus Space, its board members and assigns the right to publish and copyright my image and/or the image of my child/dependent (including audio, moving image, or photography) in any editorial and/or promotional material produced and/or published by the Madison Circus Space unless I explicitly request an exemption by mailing Madison Circus Space or emailing board@madisoncircusspace.com. MCS will make a best faith effort to honor exemption requests, but cannot guarantee that images taken at public events held at the Madison Circus Space will not contain exempted individuals. Requests for image removal will be honored whenever MCS has authority over an account. Questions, take-down requests or requests for exemptions should be addressed to board@madisoncircusspace.com.

I Agree

Additional Representations. You acknowledge you have had an opportunity to object to any or all the terms described herein and,
after careful consideration, fully understand the extent of the waiver represented by such terms in their aggregate and waive
any right to bargain for different terms. You understand that if you later learn that any fact you believed to be true at the time
you signed this Release is later found to be incorrect, you nevertheless are bound by this Release. YOU HAVE READ THIS
RELEASE THOROUGHLY. YOU SIGN THIS RELEASE VOLUNTARILY ON BEHALF OF YOURSELF, YOUR
HEIRS, NEXT OF KIN, ASSIGNS, PERSONAL REPRESENTATIVES AND RELATED INDIVIDUALS. NO ONE HAS
MADE ANY REPRESENTATIONS, STATEMENTS OR INDUCEMENTS THAT CHANGE OR MODIFY ANYTHING
WRITTEN IN THIS RELEASE.

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and events at MCS.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
What activities are you most likely to be doing at MCS?
German wheel
Aerial
Juggling
Dance
Tumbling
Hooping/Flow
Other
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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