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I have read, understand, and agreed to the following statements:

 

I acknowledge that my participation in Aerial and Acrobatic training 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 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.

 

I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Stomping Ground Atrium LLC (DBA: Stomping Ground Studio) from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Stomping Ground Studio’s equipment or facilities, including any such claims which allege negligent acts or omissions of Stomping Ground Studio.

 

Circus activities expose its participants to the usual risk of cuts and bruises. Other more serious risks exist as well. Participants can fall off equipment, sprain or break wrists and ankles. In the event that you are injured, and you may require medical assistance; it will be at your own expense.

 

I understand that classes may be cancelled by Stomping Ground Studio if an insufficient number of students are registered, and that I will be offered a credit for a similar class.

 

I agree to use studio equipment under supervision of a Stomping Ground Studio coach. I understand that only coaches are permitted to raise and lower the aerial equipment.

 

I agree to be sober during class times.

 

I agree to always use crash pads while on the apparatus. I also agree to clean and put away all crash pads and yoga mats.

 

I understand if I need to reschedule or make a cancellation, I will cancel within 12 hours of class time. If cancellation occurs within 12 hours of class time, I forfeit my class credit.

 

I understand that no refunds will be granted.

 

When training virtually with a coach, I acknowledge that my equipment is mechanically fit and suitable for my use in this program.

 

I understand that at all times during my participation in this program or lesson, I have sole responsibility for my safety.

 

If during the course of my participation in this program: (a) I learn or become aware, of a change in my health, physical, emotional or mental condition, or (b) I feel unsafe or threatened for any reason, or (c) I notice anything unsafe about the program, I will immediately stop participating and inform my coach.

 

I agree as an adult participant, or the Parent/Legal Guardian of a minor participant, in consideration of being permitted to participate in a program or lesson given by Stomping Ground Studio, grant all RELEASED PARTIES, the irrevocable right and permission to photograph and/or record me or my child(ren)/ward(s) in connection with the studio to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner in any and all media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration.

 

I waive any right to inspect or approve the use of the photograph and/or recording and acknowledge and agree that the rights granted to this release are without compensation of any kind. All photographs and/or recordings are the exclusive property of Stomping Ground Studio.

I HAVE READ THIS DOCUMENT THOROUGHLY. I UNDERSTAND THAT THE RELEASES ARE RELYING UPON MY WARRANTIES, ASSUMPTIONS, WAIVER AND RELEASE, UNDERTAKINGS AND AGREEMENTS WHEN ACCEPTING MYSELF OR MY MINOR CHILD/WARD'S PARTICIPATION IN THIS PROGRAM. I HAVE READ AND UNDERSTOOD THE RISKS AND RESPONSIBILITIES LISTED ABOVE, AND I AGREE TO BE BOUND BY THE TERMS.

Today's Date: October 17, 2021

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*

Confirm Email*
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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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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