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Rebel Aerial Artistry Waiver & Release of Liability

If at any time you feel you are at risk of injury, notify your instructor so that you may be guided out of the movement. It is important that you listen to your body and know your limits on any given day.

I understand that all forms of Aerial are for creating and maintaining good health of the mind, body, and spirit. I realize that it should not be construed as a substitute for medical examination, diagnosis or treatment, and that nothing said in the course of action should be construed as such. Aerial entails physical movements on the ground and the air. Participation in Aerial activities includes, but is not limited to, climbing apparatus, poses in the air and on the ground, sequences in the air and on the ground, and various conditioning exercises. Aerial incorporates a range of stretching and flexibility movements to help in gaining strength and confidence in the air and on various apparatus.


I understand there is an inherent risk associated with any exercise program including my voluntary participation in Aerial activities that may result in injury. The exercises related to Aerial will challenge my cardio-respiratory and musculoskeletal systems associated with; the aerobic, anaerobic, strength, power, agility, flexibility, and breathing components of the program. I understand and am aware that the components of exercise/Aerial are potentially hazardous activities that may cause injury. Additional risks include but are not limited to; exposing participants to the potential for slips and falls and falling; rope burns; pinches; scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even sever life threatening hazards; strains, sprains, cuts, bruises, muscle soreness and fractures; musculoskeletal injuries including 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 this activity. Traveling to and from shows, meets, and exhibitions raises the possibility of any manner of transportation accidents. In any event, if you or your child is injured, you or your child may require medical assistance, at your own expense. I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participating, volunteering or watching in any physical training, including this Aerial Arts program. 


I acknowledge that I have either had a physical examination and/or have been given permission from my physician to participate in a yoga based exercise program or that I have decided to participate in an exercise program voluntarily and without the approval of my physician and do hereby assume all responsibility for my participation in any exercise/Aerial Arts or activity associated with Rebel Aerial Artistry and its instructors. 


I certify that I am physically well and suffering from no medical problems, conditions, impairments, diseases, or any other illness that would prevent my full participation or increase my risk of injury and/or illness as a result of partaking in any exercise/Aerial program or other activities or workshops. 


I, my heirs, or legal representatives do hereby forever waive and release Rebel Aerial Artistry, its members, teachers, agents and employees from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from my participation in any exercise/Aerial activity, workshops, or use of any equipment. 


I understand Rebel Aerial Artistry may provide an area for personal belongings to be held during class, however, I agree that Rebel Aerial Artistry and its employees, is in no way responsible for the loss or damage of my belongings while I attend any programs, classes, or workshops. 


I understand that payment is due prior to/at the time of service unless prior agreement has been made. Cash, Venmo, Cards are accepted. 


I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions, and understand that I am waiving and giving up my right to sue Rebel Aerial Artistry, its teachers, members, agents and employees. I acknowledge that I am signing this agreement voluntarily, and intend by my signature for this to be a complete and unconditional release of liability to the greatest extent allowable by law. 



Date: April 23, 2024

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
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. As a legal guardian of the Minor(s), I consent to the above terms and conditions.


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*
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 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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