Loading...

Safety First Partnership Agreement, Assumption of Risk, and PAR-Q

In consideration of the services of Jax Beach Aerial Arts LLC and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Jax Beach Aerial Arts LLC, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows. 

  1. I acknowledge that my participation in aerial arts training and instruction, including lyra, aerial fabric, dance trapeze, and other apparatuses 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. 
  2. The risk include, but are not limited to: exposing its 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 severe 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. In any event, if you are injured, you may require medical assistance, at your own expense. I fully understand the risks associated with this exercise program.  
  3. 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 and fully at my discretion.
  4. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf 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 Studio’s (Jax Beach Aerial Arts LLC and First Coast Center of the Arts) equipment or facilities, including any such claims which alleged negligent acts.
  5. Should Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf , be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
  6. I agree to bear the costs of such injury or damage myself. I further certify that I am willing to disclose any medical or physical condition I have that may put me at risk for injury and assume the risk of any medical or physical conditions I may have.
  7. In the event I file a lawsuit against Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf, I agree to do so solely in the state of Florida, and I further agree that the substantive law of Florida shall apply in that action without regard to the conflict of law rules of that state.
  8. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
  9. By signing up for classes, private sessions, or events, the attendee grants Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf permission to use his/her likeness in a photograph and/or video in any and all materials without payment or consideration made to them. The attendee realizes these photos and/or videos become Jax Beach Aerial Arts LLC property and will not be returned. The attendee authorizes Jax Beach Aerial Arts LLC to use, edit, copy, publish or exhibit any photo or video for any lawful purpose. The attendee waives the right to obtain royalties from the photo or video. Please let Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf know if you do not wish to have you or your minor child’s picture/video made public.
  10. I understand that the Studio is operated by First Coast Center of the Arts and not by Jax Beach Aerial Arts LLC or any person and/or entity acting in behalf.
  11. I agree that any provision herein found to be illegal, invalid, or unenforceable will in no way affect the validity or enforceability of the remaining terms in the release.
  12. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Jax Beach Aerial Arts LLC and any person and/or entity acting in behalf on the basis of any claim from which I have released them herein.



Today's Date: December 21, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Tenth Participant's Name

First Name*

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

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

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:*
Emergency Contact

Please include emergency contact information. Please notify us immediately if emergency contact information changes. This is VERY important.


Name *

Phone *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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 Date of Birth*
Parent or Guardian's Health Information

In order to provide a great experience and keep your body healthy, please list any special considerations you may have:


Injuries old or new (especially shoulder)
Dizziness*
No
Yes

Other Additional Information

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

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!