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Waiver for participation in Circus Culture's activities.

CIRCUS CULTURE, LLC

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of CIRCUS CULTURE, their agents, owners, officers, 

volunteers, participants, employees, and all other Persons or entities acting in any capacity by, 

through, under or on their behalf), I hereby agree to release, indemnify, and discharge CIRCUS 

CULTURE, on behalf of myself, my spouse, my children, my parents and estate as follows:

 

1. I acknowledge that my participation in instruction and training of circus arts instruction, 

including but not limited to; aerial arts, acrobatics, balancing, juggling and other various 

disciplines 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 cannot be eliminated without jeopardizing the essential qualities of the activity.

 

2. The risks include, among other things: The hazards of slips and falls; rope burns; pinches, 

scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, 

concussions or even more severe life threatening hazards. Further risks include: Being struck 

by objects dislodged or dropped from above; the hazards from using safety ropes and 

equipment; the risks of falling off circus equipment; the risks of landing improperly; the risks of 

being entangled in the safety lines; my own physical condition, the physical exertion associated 

with this activity and the negligence of other participants, instructors, or other persons who may 

be present.

 

3. 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.

 

4. I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless

CIRCUS CULTURE from and against any and all claims, demands, suits, judgments, damages,

liability, cost or expense, or causes of action, which are in any way connected with my

participation in any activity at CIRCUS CULTURE or my use of any CIRCUS CULTURE

equipment or facilities, including but not limited to those alleging negligent acts or omissions of

CIRCUS CULTURE.

 

5. Should CIRCUS CULTURE or anyone acting on their behalf, be required to incur attorneys

fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all

such fees and costs.

 

6. 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.

 

7. 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.

 

8. By signing this document, I acknowledge that if anyone is hurt or property is damaged or

lost 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 CIRCUS CULTURE on the basis of any claim from which I

have released them herein.

 

 9. By this agreement, I permit CIRCUS CULTURE to use any photos and video footage, name, voice,

statement and portrait or picture, motion or still (analog or digital) for publicity and advertising purposes,

including, but not limited to our website, brochures, CD/DVDs, posters, blogs, Facebook, Instagram, and

all social and static media. If I would like to opt out of being included in any/all of the media above I will

contact CIRCUS CULTURE directly on a case by case basis.

 

10. When contact or medical information changes that I will notify CIRCUS CULTURE of the changes.

 

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.

 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last 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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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