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Sitka Cirque LLC Waiver Form/ Questionnaire

PLEASE BE SURE TO FILL OUT THE FORM COMPLETELY.

INCOMPLETE FORMS MAY DELAY YOUR REGISTRATION.

Terms and Conditions (please initial in space provided)

*If you are registering for a workshop or other one off event and not enrolling in monthly classes, some of the following sections will no apply to you (Examples: Registration fees, Cancellation, Autopay, and Questions related to Scholarships / Performances)*

New student Registration Fee: I understand that there is a yearly $30 individual and $50 family registration fee for September-August .


Cancellation/Refund/Transfer Policy: I understand that once payment is made all sales are final. Sitka Cirque LLC does not issue refunds except in the case of a medical emergency or if a student leaves town. In addition, funds cannot be transferred to another account. Covid quarantine is not considered a medical emergency. 


Default/Remedies:  A defaulted autopay that is not remedied within 72 hours will be subjected to a $20 fee. Cirque students are not allowed to attend classes until the payment is resolved. 


Rules and Regulations: Member acknowledges that Cirque operates under rules and regulations established for the safety and protection of its members and agrees to be bound by such rules and regulations as well by the rules and regulations subsequently approved and posted or otherwise published by Cirque. Such rules and regulations in effect from time to time are incorporated into this agreement by reference. Facilities, equipment, hours, service regulations and policies are subject to change from time to time, without prior notice, in the sole discretion of Sitka Cirque LLC. Members agree to accept such reasonable changes as a condition of membership. Member additionally recognizes:

A. Under no circumstances shall members use the equipment in any manner not authorized by Sitka Cirque LLC.

B. Sitka Cirque LLC shall not be responsible for any lost or stolen items.

C. Proper attire will be worn at all times. Jewelry & watches must be removed. Piercing must be removed or covered with tape. Hair that is long enough to cover the face must be secured back. Clothing must be form fitting and cover the back, armpits, abdomen and area behind the knees. No zippers snaps or buckles on clothing. Failure to comply with these safety rules may result in a student being asked to sit out.

D. If a student is late and misses warmups they will be asked to sit and watch class.


Release and Waiver of Liability. Waiver of liability must be on file with Sitka Cirque LLC. 


Prohibited Activities: Alcohol, drugs, and smoking are prohibited within the facility. Members agree not to use the facility or engage in any activity at Sitka Cirque LLC while under the influence of drugs, alcohol or medication that may impair members ability. No weapons of any kind are allowed. 


Binding Effect. This agreement shall be binding upon, inure to the benefit of, and be enforceable by the parties hereto and their respective successors and assigns. 


Suspension and Termination: I understand that Sitka Cirque LLC may suspend or terminate my membership at any time, in it sole and absolute discretion for non-payment of membership fees or for any violation of any of Sitka Cirque LLC’s policies and procedures, and that in doing so, Sitka Cirque LLC assumes no further liability to adhere to the terms of this agreement. 


Acceptance of Terms. As a participant/parent I understand that the student is entitled to use the facility within the scope of the membership that I have selected, and that I am obligated to pay my dues and fees regardless of whether or not the student attends classes. I agree to promptly update Sitka Cirque LLC of any change in my credit card information. 


Photographs: Sitka Cirque LLC have permission to use photographs of myself or my child online or for any media/advertising. 


 

I HAVE READ SITKA CIRQUE LLC COVID PLAN. I UNDERSTAND AND ACCEPT THESE TERMS. 


I HAVE READ AND UNDERSTAND THE AUTO PAY CONTRACT CANCELATION POLICY.   


I have read and understood Sitka Cirque’s Studio Rules. 


I certify that I have read the foregoing membership agreement and that by signing below I acknowledge that I understand and agree to be bound by all the terms and conditions hereof. I further acknowledge that a fully executed copy of this membership agreement has been provided to me.

Signature of Cirque student or guardian:

Date: May 2, 2024


AutoPay - Monthly Credit Card Payment Required for registration 

PAYMENT 

Contracts are set for Sep - May so that if you plan to continue in the spring you do not need to re enroll. If you would like to cancel your Spring contract you must email Sitkacirque@gmail.com by  DEC 8th.  

Contracts may not be canceled mid semester except in the case of a medical emergency. 

Rules and Cancellation Policy

Autopay: During the contract you are responsible for all payments, regardless of class attendance. There will be no refunds or transfers. A $20 decline fee will be added to each month that we are unable to receive funds via the electronic fund transfer.

Cancellation Policy: If by reason of death, permanent disability, suddenly moving away from Sitka or severe medical illness, and the buyer is unable to continue the membership, buyer or buyer’s estate shall be relieved from the obligations of this contract. No refund will be granted for dues incurred before Cirque was notified of the need to cancel. Notification must be given in writing to sitkacirque@gmail.com a minimum of 1 week prior to the next billing cycle and will be canceled for the following monthly bill cycle. Payments are processed on the 1st of the month. Students will not be released from their contract due to a change in our Covid Policy.  If you would like to cancel your spring contract you must email Sitkacirque@gmail.com by DEC 8th. Contracts can not be canceled mid semester except in the case of a medical emergency. 

Signature of Cirque student or guardian:

Date: May 2, 2024

ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE BUYER COULD ASSERT AGAINST THE SC LLC AS A RESULT OF THIS CONTRACT. RECOVERY BY THE BUYER SHALL NOT EXCEED THE TOTAL AMOUNT PAID BY THE BUYER TO SC LLC PURSUANT TO THIS CONTRACT. IN THE EVENT SC LLC CLOSES AND CEASES DOING BUSINESS, YOU ARE NO LONGER OBLIGATED TO MAKE PAYMENTS UNDER THIS AGREEMENT.



PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Sitka Cirque LLC, their agents, owners, officers, volunteers, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "SC"), I hereby agree to release, indemnify, and discharge SC, 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 circus arts, aerial arts, dance, and gymnastics training 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; musculoskeletal injuries including head, neck and back injuries; transmissible pathogen or disease; my own physical condition, and the physical exertion associated with this activity; the negligence of other participants, or other persons who may be present. Traveling to and from shows, meets and exhibitions raises the possibility of any manner of transportation accidents.

Furthermore, SC personnel have difficult jobs to perform. They seek safety, but they 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 SC 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 SC's equipment or facilities, including any such claims which allege negligent acts or omissions of SC.

4. Should SC 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 SC, I agree to do so solely in the state of Alaska, 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 SC 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 SC. 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.

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 SC 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 SC. 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.

Signature of Participant or Parent/Guardian:

Date: May 2, 2024

207 Smith Street ● 907 623 0751 ● sitkacirque@gmail.com


Find us online website: sitkacirque.com ● facebook & instagram: sitka cirque






First Participant's Name

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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

First Name*

Last Name*

Emergency Contact's Phone Number*
Financial Aid & Work Exchange Info
Payee is tax exempt*
No
Yes
I would like to apply for Work Exchange with Sitka Cirque LLC (Please email us to schedule an appointment to go over work exchange contract & Schedule) *
No
Yes
I am eligible for the SC 10% family discount. (The Family discount becomes active when multiple family members are taking more than 1 class/week. Your FD will be applied to your monthly payments once your registration is complete.) *
No
Yes
I have applied for a Friends of Sitka Circus Arts scholarship (Register as usual and your scholarship will be applied to your future payments.) *
No
Yes
I have applied for a scholarship from another entity (Register as usual and your scholarship will be applied to your future payments once Sitka Cirque receives your funding.) *
No
Yes
Do you have any Allergies or any pre-exiting medical conditions that you'd like you or your child(ren)'s coaches to know about?

Please list any relevant information here
PERFORMANCE OPPORTUNITIES
Winter Showcase Dec 9th-10th 2023. (You must be level 3-6 for this performance. A $20-$30 costume rental fee for each costume used will be Charged to your CC on file unless you provide your own costume. ) *
No
Yes
Spring Recital Under the Big Top goes to Outer Space (You must be a Kinder level student or older to perform. The costume fee for this show will be $75 + tax for class pieces. Troupe students will be charged $75 for their class costume + $20-$30 rental for their troupe piece. Costumes will be ordered in October so look out for a charge to your CC in October or November. Costume fees are not refundable but you will get to keep your class costume. Dates for UBT goes to Outer Space. Casting will be decided in January. April 20-21 Under the Big Top Performance Cast A April 27th - 28th Under the Big Top Performance Cast B) *
No
Yes

List family members (if any) who would be performing in the optional performance opportunities listed above.

PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18) 

In consideration of the Minor(s) ("Minor(s)") being permitted by SC to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless SC from any and all claims which are brought by, or on behalf of Minor(s), and which are in any way connected with such use or participation by Minor(s).



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 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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