Name of Student_______________________________
(Name of Parent/Guardian if under 18)____________________________
Birthdate:__________________________________
Address:____________________________________________________
City/Town___________________________Phone__________________________________
E-mail address__________________________
Preferred method of contact_________________________________________
How did you hear about us?
~Friend(Name):________________ ~Google:______ ~Facebook:_____
~Instagram:______ ~Other (Please list):_______________________________
_____Check here if you DO NOT allow the reproduction and publication of my/my child's photograph(s)
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Akasha Liability Waiver and Release Form
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In consideration of the services of Akasha Aerial 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 Akasha), I hereby agree to release, indemnify, and discharge Akasha, 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 hoop, aerial fabric, pole and other disciplines 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 risk include, among other things: exposing its participants to the potential for slips and falls and falling; rope burns; silk 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. 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.
Furthermore, Akasha employees and volunteers have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness, medical conditions, or abilities. They might misjudge the weather or other environmental conditions. 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 Akasha 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 Akasha’s equipment or facilities, including any such claims which allege negligent acts or omissions of Akasha.
4. Should Akasha 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 conditions I may have.
6. In the event that I file a lawsuit against Akasha, I agree to do so solely in the state of Washington State, and I further agree that the substantive law of Washington 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.
Signature required on back
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 Akasha on the basis of any claim from which I have released them herein.
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/ Legal Guardian ___________________________
Print name_______________________________________
Date_____________________________
ADULT SIGNATURES ONLY
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Cancellations and Refunds Policy
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If a client has purchased a package, there will be no refunds on unused classes past expiration date. Most packages expire after three months. There will be no refunds if a student or parent cancels within 24 hours. You are considered late and a no show if you arrive more than 15 after the start of training. Your training spot will be given to the next person on the waitlist. There will be no refunds if a student cannot attend class because they are past their 15 minute window. All private clients must cancel a lesson no less than 24 hours in advance or there will be a $30 cancellation fee. 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 Akasha Aerial Arts and Akasha LLC on the basis of any claim from which I have released them herein. 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/ Legal Guardian ___________________________
Print name_______________________________________
Date_____________________________
ADULT SIGNATURES ONLY
Drugs and Alcohol Policy
Drugs and alcohol are not allowed in/at the studio. Any Student/persons(s) found to be intoxicated will be removed from Akasha and may return, once no longer intoxicated, at the discretion of Akasha. Please do not come into the studio for training if you are intoxicated, you will not not be able to train and you will not receive a refund.
I have read and fully understand the drugs and alcohol policy.
Signature of participant or Parent/ Legal Guardian ___________________________
Print name_______________________________________
Date_____________________________
ADULT SIGNATURES ONLY
Harassment and Abuse Policy
Position Statement
Akasha is committed to providing a sport and work environment in which all individuals are treated with respect and dignity. Each individual has the right to participate and work in an environment which promotes equal opportunities and prohibits discriminatory practices. Akasha will not tolerate harassment among its members, participants and employees. Harassment takes many forms, but can generally be defined as comment, conduct or gesture directed toward an individual or group of individuals, which is insulting, intimidating, humiliating, malicious, degrading or offensive. Sexual harassment refers to any sexual advances, requests, suggestions or activity of a sexual nature that is unwelcome by the recipient. Harassment is discriminatory, degrading and threatening. In its most extreme forms, harassment can be an offence under Washington’s Criminal Code.
Akasha strives to provide the safest possible environment for all of our participants. We encourage all of our member associations to do whatever is required in their circumstances to eliminate and protect against all forms of harassment. To assist in meeting this goal, Akasha will provide to all member associations, upon request, up to date literature on the subject. The objective is to make aerial arts a sport in which children and adults can feel safe training and in which parents can feel safe having their children train.
Akasha strongly encourages all of its members to learn to recognize and understand what constitutes harassment. An individual, who perceives any activity as a form of harassment, should be encouraged to tell the offending party that the activity is not appreciated. If the offending behaviour continues, the complainant should be encouraged and supported in notifying the appropriate authorities, including the owner. The authorities should act promptly and with integrity, while respecting the rights of all those involved. If someone in authority uses his/her power or position to harm another, whether emotionally, physically or sexually, this is abuse. If a person is threatened, intimidated, taunted or subjected to racial, homophobic or sexist slurs, this is harassment. Emotional and physical abuses are attacks on a child’s self-esteem and can be psychologically damaging. Name calling, threatening, ridiculing, intimidating, isolating, hazing or ignoring a player’s needs are examples of emotional abuse and should not be tolerated at any level.
Signature required on back
Any purposeful attack on a student, instructor or anyone inside Akasha such as slapping, kicking, hair pulling, shaking, shoving, grabbing, etc. can be physical abuse and is both offensive and unacceptable.
Akasha Aerial Arts encourages all of its member associations to report situations that are deemed to be harassment or abuse immediately to the owner, Jennifer Wang. The Local owner is encouraged to have in place measures to deal with such a situation in an expedient and fair manner.
By signing I understand and agree with the above statement and will not harass or abuse. If I see harassment and abuse I will report it to the owner. If I violate the harassment and abuse policy, I understand I will not be allowed to return to Akasha. NO REFUNDS FOR VIOLATORS.
Signature of participant or Parent/ Legal Guardian ___________________________
Print name_______________________________________
Date_____________________________
ADULT SIGNATURES ONLY
Photo Release Consent
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Dear Participants:
During training sessions, we like to take photographs or videos of students in training to share the school's positive vibe. It helps students when they can see their own improvement and builds confidence. Incidentally, some photographs may capture your child's participation, directly or indirectly.
These photos may be published through our website, social media pages, news bulletins, billboards, and ads.
With this, we seek your consent in allowing us to publish photos which may involve your child to the said platforms. Please do provide your response by selecting your choice below and submitting this form:
_____I hereby allow the reproduction and publication of my/my child's photograph(s)
______I do not allow the reproduction and publication of my/my child's photograph(s)
Signature of participant or Parent/ Legal Guardian ___________________________
Print name_______________________________________
Date_____________________________
ADULT SIGNATURES ONLY