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New Moon Movement Arts
7601 Greenwood Avenue N
Seattle, WA 98103

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK


In consideration of the services of New Moon Movement Arts, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "New Moon"), and for the use of the Premises of New Moon Movement Arts (“Premises”) I hereby agree to the terms of the following release (“Release”) on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate.


1. I acknowledge that my participation in aerial arts, athletics, gymnastics training and instruction and other various disciplines (“Activities”) may entail both 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 are inherent to the Activity.


2. The risks include but are not limited to: 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; the negligence of other people; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with this activity.


3. I am aware of the contagious nature of bacterial and viral diseases, including the 2019 novel coronavirus and potentially other infectious future disease(s) (collectively the “Disease”) and the risk that I may be exposed to or contract the Disease by being at or in New Moon and engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, and/or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including New Moon employees. I understand that while New Moon has implemented preventative measures designed to reduce the spread of the Disease, New Moon cannot guarantee that I will not become infected with the Disease while on the premises of New Moon and that being on the Premises of New Moon may increase my risk of contracting the Disease.


NOTWITHSTANDING THE RISKS ASSOCIATED WITH THE DISEASE OR MY PARTICIPATION IN THE ACTIVITY, I ACKNOWLEDGE THAT I AM VOLUNTARILY ENTERING THE PREMISES TO ENGAGE IN THE ACTIVITY WITH KNOWLEDGE OF THE RISKS AND DANGER INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF PERSONAL INJURY, ILLNESS, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE RELATED TO THE DISEASE, ARISING FROM MY BEING ON THE PREMISES, OR ENGAGING IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF NEW MOON OR OTHERWISE.


4. I hereby expressly waive and release any and all claims, now known or hereafter known, against New Moon, and its owners, employees, agents, affiliates, successors, and assigns (collectively, “Releasees”), on account of injury, illness, disability, death, or property damage arising out of or attributable to my being on the Premises of New Moon,  engaging in the Activity, or being exposed to or contracting the Disease, whether arising out of the ordinary negligence of  New Moon or any Releasees or otherwise. I covenant not to make or bring any such claim against New Moon or any other Releasee, and forever release and discharge New Moon and all other Releasees from liability under such claims. This waiver and Release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that Washington State law does not permit to be released by agreement.


5. I shall defend, indemnify, and hold harmless New Moon and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by or awarded against New Moon or any other Releasees arising out or resulting from any claim of a third party related to the Disease, due to my engaging in the Activity, or being on the Premises, including any claim related to my own negligence or the ordinary negligence of New Moon.


6. 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.


7. This Release constitutes the sole and entire agreement between myself and New Moon with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of New Moon and me and our respective successors and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of Washington without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Washington State and I hereby consent to the exclusive jurisdiction of such courts.


BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.


I represent that I have fully and accurately completed the medical information section of this form and assert that I have no physical condition that would prevent or endanger me during my participation.  In the event of an injury, I authorize New Moon and its employees, agents, or those they deem fit, to administer first aid, transport me to a hospital, initiate medical treatment, and hold me until my emergency contact can be notified.



First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Medical Information
Do you have any of the following conditions?
Allergies
Asthma
Back Injuries
Epilepsy
Joint Injuries
Orthodontic Appliances
Pregnant or postpartum
Recent Surgery
Vision or hearing impairment
Any other medical, learning, or sensory issues we should be aware of?

If yes to any of the above, please explain.
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*

Middle Name

Last Name*

Relationship*

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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