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Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement

Participant/Performer Agreement:

 

I AGREE THAT BY SIGNING THIS DOCUMENT THAT I WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE 

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of Island Circus Space accepting my application to participate in but not limited to aerial/acrobatic activities, juggling, trampoline, classes, workshops, open training, jams, collaborations, or performances, in conjunction to Island Circus Space (all of the foregoing collectively the "Activities") I agree that:

  • The Activities associated with Island Circus Space involve known and unknown risk of accident, physical or emotional injury, paralysis, disability, death, or damage to yourself, to property, or to third parties, including the loss of any accessory, equipment or personal belongings. The risks include, without limitation, 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 sever life threatening hazards; strains, cuts, bruises, muscle soreness and fractures; musculoskeletal injuries including but not limited to head, neck and back; injuries to internal organs; the negligence of other people; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with these Activities (all the foregoing collectively a "Loss"). 
  • In exchange for being allowed to participate in the Activities I hereby release, indemnify, forever discharge and hold harmless Island Circus Space, any related or affiliated companies, its shareholders, directors, officers, volunteers, participants, advisors, agents, employees, consultants, third parties and any other persons or entities acting in any capacity on their behalf (the foregoing collectively the "Releasees"), from any liability or responsibility, directly or indirectly in connection with a Loss, and any and all claims, demands, or causes of action, which are in any way connected with my participation in the Activites or my use of Island Circus Space's equipment or facilities, including any such claims which allege negligent acts or omissions of the Releasees 
  • I release and indemnify the releases from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I may suffer as a result of my participationin this activity, due to any cause whatsoevery, including negligence, breach of contract or breach of statutory duty of care, including any duty of care owed under the Occupiers Liability Act and further including the failure on the part of the Releasees to safe guard or protect me from the Loss described above. 
  • I acknowledge and am aware that physical touch in the form of spotting by instructors and other students is required in order to appropriately facilitate a safe learning environment.
  • The undersigned gives permission to Island Circus Space Directors and staff to seek medical treatment for the participant in the event they are not able to reach a parent or guardian
  • If any portion of this agreement is found to be void or unenforcable, the remaining document shall remain in full force and effect.

 

PRIVACY POLICY

The personal information contained in this file and any other stored information will be kept confidential by Island Circus Space through the use of an online storage service. Only persons in the direct employ of Island Circus Space, and who require this information in the performance of their duties, will have access to it. However, Island Circus Space cannot guarantee the privacy of your information against unauthorized access and is not liable for any intrusions of privacy by a third party including online hacking, robbery, or otherwise unauthorized possession or loss of any stored data or personal information. 

PROHIBITIONS

The use of any electronic device including but not limited to cellular phones, cameras, video cameras are prohibited during any instructional class unless prior authorization has been given by Island Circus Space. In such a case, recorded material shall not be reproduced in any manner whatsoever, including without limitation to personal promotion or reproductions on any websites, social media or other unless prior written authorization has been given by Island Circus Space.

Abuse or inappropriate behaviour directed towards Island Circus Space or any of its members in any form will not be tolerated. Island Circus Space reserves the right to ask anyone to leave the premise should they deem the behaviour to be, without limitation, inappropriate, abusive, or otherwise harmful to the physical, emotional and intellectual integrity and safety of other persons participating in or observing or instructing the Activities of Island Circus Space.

MEDIA RELEASE

I hereby agree that by participating in the Activities of Island Circus Space, without limitation, any photos, videos or recordings taken by Island Circus Space directors or others hired by Island Circus Space during classes, may be used for promotional purposes including but not limited to social media, posters, advertisement and website content with sole ownership of said recordings or photos belonging to Island Circus Space.

ARTISTIC OWNERSHIP

We, Island Circus Space, retain full ownership over any and all productions and choreography created for the use of performances with Island Circus Space including but not limited to intellectual property, in any materials or works created by or contributed to by the participant (including ideas, concepts, proposals, project plans, performances, choreography) in the Activities by the participant or using the resources of the company, are owned by Island Circus Space. The participant agrees that Island Circus Space may reproduce, assign, license, adapt, translate, edit, modify and otherwise use any such works in its absolute discretion. The participant agrees that they do not possess the rights to reproduce said intellectual property outside of the use of Island Circus Space.

CANCELLATION POLICY

Island Circus Space reserves the right to cancel and/or reschedule classes as required

Progressive Session Classes:

  • Up until 5 days before the start of the session: a full refund will be granted
  • Five days until 24 hours before the start of the session: a 50% refund will be granted (exception: a full refund will be provided in the presence of a note from a medical doctor, clearly stating the signing Doctor’s name)
  • Within 24 hours of the start of the session and throughout the session: no refunds will be granted (exception: a 50% refund of the classes missed will be provided in the presence of a note from a medical doctor, clearly stating the signing Doctor’s name)
  • Make-up classes for missed classes during a session are not provided

Drop in Classes:

  • Up until 24 before the start of class: class deferrals are provided (no cash refunds)
  • Less than 24 hours from the start of the class a 50% refund will be provided in the presence of a valid note from a medical doctor
  • No refunds for unused classes on punch cards

Circus Parties:

  • Up until 10 days prior to the event date: the deposit is 100% refundable and the date and time can be switched at no charge
  • Up until 48 hours prior to the event date: the deposit is 50% refundable and the date and time can be switched at no charge
  • Within 48 hours of the start of the class: the deposit is non-refundable and the date or time can be switched for a $25 fee

I Agree

 

I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I AM AWARE THAT BY SIGNING THIS DOCUMENT I AM WAIVING CERTAIN RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH I MAY HAVE AGAINST ISLAND CIRCUS SPACE AND OTHERS.

I Agree

Signed this date: December 11, 2019

 

To proceed please click:

"Adult" if participant is 18 years or older

"Minor" if participant is less than 18 years old


 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
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 discounts by e-mail.
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Gender *
Male
Female
Neutral
Rather not say

Please identify any allergies you have that we should be aware of

Please identify any conditions (physical, emotional, psychological or other) that we should be aware of including social disorders or previous significant injuries

How did you hear about us?
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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