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Liability Waiver, Agreement, Release and Assumption of Risk

In consideration of permission to use, today and on all future dates, the property, facilities, staff, equipment and services of ​Santa Cruz Circus Arts,Santa Cruz Cheer Athletics,  Wayne Shaffer , its agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, and in consideration of the services provided by Santa Cruz Circus Arts LLC, Nathan and Angela Lackey their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Wayne Shaffer, Santa Cruz Cheer Athletics, Santa Cruz Circus Arts, Nathan and Angela Lackey, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

Assumption of Risks: Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I acknowledge that my participation in any of aerial, dance, fitness, training, classes or workshops at  Santa Cruz Cheer Athletics,Santa Cruz Circus Arts LLC, or with Nathan and Angela Lackey or their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf including but not limited to any aerial apparatus, tumbling, dance, yoga, and ground based acrobatics. The specific risks vary from one activity to another, but the risks range from: 1) minor injuries such as scratches, bruises, and sprains, 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, 3) catastrophic injuries including paralysis and death. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. 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.

Insurance: 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.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Wayne Shaffer, Santa Cruz Cheer Athletics, Santa Cruz Circus Arts LLC, Nathan and Angela Lackey or their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees brought as a result of my involvement at and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in activities at Santa Cruz Circus Arts LLC,  Santa Cruz Cheer Athletics, 125-A Post Street, Santa Cruz, CA 95060 ,  or with Nathan and Angela Lackey or their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf I may be found by a court of law to have waived my right to maintain a lawsuit against Wayne Shaffer, Santa Cruz Cheer Athletics, Santa Cruz Circus Arts LLC,or with Nathan and Angela Lackey or their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf on the basis of any claim from which I have released it herein. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

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.

Clothing: No jewelry such as rings, necklaces, bracelets, or dangling earrings allowed in class. Long hair must be tied back. For Aerial, please wear tight fitting tops with full frontal coverage and leggings or tight pants below the knees. For Pole, please wear shorts and a tank top. For Cheer:Tennis shoes are required

Minors: We ask that children under 7 years of age have a parent or guardian present for the duration of class. Minors (under 18 years) must have a parent/guardian pick them from the studio at the end of class. If you would like your child to leave the studio alone (pick up downstairs, ride their bike, etc.), please provide written permission to your childs teacher. 

No Refunds: Please keep in mind while purchasing class packs that we are not able to offer refunds for unused classes. 

24 Hour Cancellation Policy: 24 hours is required for cancellation of a class you are registered in. If we do not receive notification 24 hours ahead of your scheduled class you will be charged full price for the class. 

Dated: August 8, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

First Participant's Signature*
Second Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Third Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Fourth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Fifth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Sixth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Seventh Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Eighth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Ninth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Tenth Participant's Name

First Name*

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

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive the Santa Cruz Circus Arts Newsletter.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
For Minor's Only

Parent/Guardian

Phone #'s
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Medical Conditions:

Medications:

Media Release: I understand that photographers and/or media/production crews may sometimes be present photographing or filming classes, rehearsals, coaching sessions, workshops, or presentations. I give my permission for resulting photographs and/or television/films footage, which may include myself to be used by Aerial Arts Santa Cruz for promotional purposes on television, newspapers, cyberspace, programs, magazines, or any other media. I waive any rights of compensation or ownership thereto.. 

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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