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Participant Agreement, Release, and Assumption of Risk


In consideration of the services of 6lackeys, LLC, Santa Cruz Circus Arts LLC, DBA Cirque, Tumble, Cheer, their agents, officers, volunteers, employees, and all other persons or entities acting in any capacity on behalf (hereinafter collectively referred to as "CTC"), I hereby agree to release, indemnify, and discharge CTC, 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 manipulation skills, tumbling, cheerleading, drama skills, aerial arts training, Cyr Wheel, Pole, Dance and instruction activities 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.

The risks include, among other things: slips and falls; falling from equipment; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; strains, cuts, bruises, muscle soreness and fractures; musculoskeletal injuries including head, neck, and back; injuries to internal organs; transmissible pathogen or disease; the negligence of other participants or persons who may be present; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with this activity.

Furthermore, CTC personnel have a difficult job to perform. They seek safety but are not infallible. They might be unaware of a participant's fitness or abilities. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

2. 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.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless CTC 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 CTC's equipment or facilities, including any such claims which allege negligent acts or omissions of CTC.

4. Should CTC or anyone acting on their 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.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

6. In the event that I file a lawsuit against CTC, I agree to do so solely in the state of California, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. 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.

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 CTC on the basis of any claim from which I have released them herein. I also agree that this document is valid for subsequent visits and participation at CTC.

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 Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
Parent or Guardian's Email Address

Email*

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

Street *

City *

State *

Zip Code
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 Date of Birth*
Parent or Guardian's Photo, Video, and Media

I grant permission to create, copy, reproduce, exhibit, publish, or distribute, any likeness of myself, my belongings, my children to be used for the purpose of promotional material.

I understand that the above uses may include, but are not limited to video, sound recordings, photographs, displays, brochures, web sites, multi-media programs, or any other type of promotional medium existing now or in the future.

I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons, and organizations.

I consent to the photo, video, media release.*
Yes
No
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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