Loading...

STATEMENT OF VOLUNTARY CONSENT RELEASE AND WAIVER OF LIABILITY FOR PARTICIPATION IN THE FLORIDA STATE UNIVERSITY FLYING HIGH CIRCUS

      In consideration of my participation in the Florida State University Flying High Circus during Academic Year 2024-2025, and having personal and actual knowledge and appreciation of the particulars of the facilities and programs and those risks involved in circus activities, including, but not limited to, broken bones, spinal injuries, concussions, rope burns, cuts, scrapes and bruises, and for other good and valuable consideration received by me, receipt of which is hereby acknowledged, I voluntarily consent to using FSU facilities and participating in the Florida State University Flying High Circus program and its related activities described herein, and hereby agree to assume the risks arising therefrom.

      I knowingly and voluntarily accept all risks and agree to relieve the Florida State University Flying High Circus and the Florida State University Board of Trustees, including their employees, agents, representatives, assigns and successors, of any responsibility, liability, or cost for any accident or injury of any nature to me arising from my participation, including assuming any costs, including medical costs, as a result of such accident or injury in connection with the activities and use of facilities and equipment associated with my participation in the Florida State University Flying High Circus program.

      I waive any and all claims I may have in the future, including claims of negligence and gross negligence as a result of my participation and give up and forever release my right to file any lawsuit against the Florida State University Flying High Circus, the Florida State University Board of Trustees, the Florida Board of Governors, and the State of Florida, including their employees, agents, representatives, assigns and successors, involving any accident or injury to me resulting from my participation in any activity, use of facilities and equipment associated with my participation in the Florida State University Flying High Circus program.

      I further understand and agree that the Florida State University, the Florida State University Board of Trustees, the Florida Board of Governors, and the State of Florida does not provide any indemnification or insurance coverage, such as life, accident, automobile, or health insurance coverage, for such program, except as may be allowed by Section 768.28, Florida Statutes.

      I hereby authorize emergency medical treatment for myself, at my expense, if the need arises.

      I HEREBY declare and represent that in making, executing and tendering this Statement of Voluntary Consent Release/Waiver of Liability, I understand and acknowledge that I am relying wholly upon my own independent judgment, belief and knowledge of the circumstances involved in my participation in the described activity, and that I have read this statement, understood its contents, and executed it of my own free will and choice.

      I am over eighteen (18) years of age. If not, then I have obtained my parent/guardian’s signature on this release.

I Agree

 

NAME, IMAGE, VOICE AND/OR LIKENESS RELEASE

For valuable consideration received, the undersigned hereby irrevocably consents to and authorizes the use by the Florida State University ("University") of the undersigned's name, image, voice and/or likeness as follows: The University shall have the right to publish, re-publish, adapt, exploit, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or re-use the undersigned's name, image, voice and/or likeness in connection with any product or service in all markets, media or technology now known or hereafter developed in perpetuity throughout the universe, including advertising, promoting and merchandising the product or service. University may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or nonprofit.

I Agree

Today's date: December 26, 2024

 



Please select who will be participating...
AdultMinor
Continue
First Student's Name

First Name*

Last Name*
First Student's Age Acknowledgment*
First Student's Date of Birth*
I certify that I am 18 years of age or older
First Student's FSUID

Please enter FSUID *

Your FSUID is your username for my.fsu.edu and Canvas.


First Student's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's FSUID

Please enter FSUID *

Your FSUID is your username for my.fsu.edu and Canvas.


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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!