(Vertical Dance) PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Project Bandaloop, their agents, officers, volunteers, employees, and all other persons or entities acting in any capacity on behalf (hereinafter collectively referred to as "PB"), I hereby agree to release, indemnify, and discharge PB, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in aerial arts 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, bruises, muscle soreness and fractures; musculoskeletal injuries including head, neck, and back; injuries to internal organs; transmissible pathogen or disease; 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.

Furthermore, PB personnel have a difficult job to perform. They seek safety but 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.

1. 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.

2. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless PB 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 PB's equipment or facilities, including any such claims which allege negligent acts or omissions of PB.

3. Should PB 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.

4. 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.

5. In the event that I file a lawsuit against PB, 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.

6. The undersigned waives the protection afforded by any statue or law in jurisdiction whose purpose, substance, cause and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing this release. This means, in part, that the undersigned is releasing unknown future claims and specifically waives the provisions of California Civil Code Section 1542 which provides: A general release does not extend to claims that the creditor or releasing party does not know or suspect exist in his or her favor at the time of the executing the release and that, if know by him or her, would have materially affected his or her settlement with the debtor or released party.

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 PB 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 PB.

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.

April 25, 2024

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Second Participant Name

First Name*

Last Name*

Phone*

Second Participant Date of Birth*

Second Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Third Participant Name

First Name*

Last Name*

Phone*

Third Participant Date of Birth*

Third Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Fourth Participant Name

First Name*

Last Name*

Phone*

Fourth Participant Date of Birth*

Fourth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Fifth Participant Name

First Name*

Last Name*

Phone*

Fifth Participant Date of Birth*

Fifth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Sixth Participant Name

First Name*

Last Name*

Phone*

Sixth Participant Date of Birth*

Sixth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Seventh Participant Name

First Name*

Last Name*

Phone*

Seventh Participant Date of Birth*

Seventh Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Eighth Participant Name

First Name*

Last Name*

Phone*

Eighth Participant Date of Birth*

Eighth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Ninth Participant Name

First Name*

Last Name*

Phone*

Ninth Participant Date of Birth*

Ninth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Tenth Participant Name

First Name*

Last Name*

Phone*

Tenth Participant Date of Birth*

Tenth Participant Information

Indicate which education program you or your minor are participating in. *

If participant is under the age of 18, indicate full name.

Pronouns

MEDICAL: ALLERGIES/CURRENT MEDICATIONS

MEDICAL: INJURIES (Past + Present)

HARNESS SIZE: measured by waist size which is around the belly button.*

XXXS (22-28)

XXS (Waist 24-26.5)

XS (Waist 26.5-29)

S (Waist 29-31.5)

M (Waist 31.5-35)

L (Waist 35-39)

Other

Prefer not to answer

MOVEMENT EXPERIENCE: Briefly describe your movement experience.

ANYTHING ELSE? Provide any additional information you would like us to know.

Participant 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*

Confirm Email*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

The following demographic questions are optional, confidential, and collected for grant reporting purposes only.

Race / Ethnicity

Gender

Sexual Orientation

Do you have a disability?

Served in the armed forces?

Yearly Household Income

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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