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Flying Gravity Circus Youth Indemnification Waiver

Flying Gravity Circus programs include but are not limited to: Blue Troupe, Green Troupe, Purple Troupe, Pre-Troupe, Preparatory Class, Troupling Tumble, Circus Play, Family Circus Play, Open Studio, Silver Lining Circus Camp, Circus-in-a-Box, Adult Classes, Private Lessons, Circus After School Programs, Circus Workshops, and Circus Residencies.

 

PLEASE READ CAREFULLY BEFORE SIGNING - THIS AFFECTS YOUR LEGAL RIGHTS.

Parent or Guardian of Participant, hereby warrants that the participant is in good health and capable of the physical demands of training and performing in a circus arts program.

 

PARENT OR GUARDIAN realizes and is fully aware that training, rehearsal, and performance in a circus arts program can expose participant to physical risks and hereby agrees on behalf of participant that PARENT OR GUARDIAN and participant assume all risk of injury or loss resulting from participation in said program.


 

PARENT or GUARDIAN does hereby on behalf if himself/herself and his/her CHILD/WARD, and their heirs, administrators, executors, and assigns, agree to release, hold harmless, and forever discharge FLYING GRAVITY CIRCUS, JONATHON ROITMAN, JACQUELINE DAVIS, FLYING GRAVITY CIRCUS STAFF, FLYING GRAVITY CIRCUS TRUSTEES, HIGH MOWING SCHOOL, HIGH MOWING FACULTY AND STAFF, and any other person officially connected with said program or their respective heirs, legal representative or assigns of and from any and all claims, demands, liability, right or causes of action of whatsoever kind of nature including, but not limit to, claims of negligence which PARENT OR GUARDIAN OR CHILD/WARD may have, arising from or in any way connected with any injuries, losses, damages, disability, suffering, property damage or loss, or results thereof, which may be sustained by the participant as a result of his/her involvement in the circus arts program.

 

PARENT OR GUARDIAN on behalf of himself/herself and his/her CHILD/WARD agrees further that in the event any suit is brought by or on behalf of PARENT OR GUARDIAN or CHILD/WARD to recover damages for any claim covered by this release, he/she will indemnify FLYING GRAVITY CIRCUS, JONATHON ROITMAN, JACQUELINE DAVIS, FLYING GRAVITY CIRCUS STAFF, FLYING GRAVITY CIRCUS TRUSTEES, HIGH MOWING SCHOOL, HIGH MOWING FACULTY AND STAFF, respective heirs, legal representatives or assigns for all losses or costs associated with any such lawsuit including, but not limited to, any damages awarded and reasonable attorneys' fees and costs incurred.

 

I, as PARENT OR GUARDIAN of a participant in a FLYING GRAVITY CIRCUS performance, training and/or teaching program, confirm that the participant is insured as in the Health, Emergency, and Media Form and understand that the above paragraphs constitute covenant and a promise on my part to fully discharge the above parties from any and all liability for the injuries or the loss resulting from the participant's involvement in any program of FLYING GRAVITY CIRCUS. I understand that this is a binding contract and that my signature is required in order for my CHILD/WARD to participate in a FLYING GRAVITY CIRCUS program.

 

THIS IS A RELEASE OF LIABILITY. I HAVE READ THIS RELEASE AND I VOLUNTARILY SIGN SAME.

 

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy 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*

Middle 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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