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Minor liability Waiver + intake form

Completion of this waiver and form is required for any minor to participate in any class, party, or private before their first time visiting the studio. It only has to be filled out once, and will be kept on file on your account for internal use only. Thank you for filling it out!

The individual named below (referred to as "I" or "me") on behalf of themselves, their child or children (referred to as “Child”) and their spouse, partner, co-guardian, immediate relatives or any other person who claims the Child as a dependent, desire to authorize the Child to participate in any capacity, including but not limited as student, dancer and spectator, in aerial arts-related activities, including but not limited to aerial, pole and circus classes, presentations, recitals, camps, physical activities, and engaging in
fitness or strength and endurance workouts (whether singular or plural, hereinafter referred to as the "activities") provided and promoted by Studio Rouge Aerial Arts LLC a.k.a Studio Rouge, an Ohio limited liability company (the "Company"). In consideration of being permitted by the Company to participate in the Activities and in recognition of the Company's reliance hereon, I agree to all the terms and conditions set forth in this RELEASE OF LIABILITY, WAIVER, ASSUMPTION OF RISK AND IMAGE RELEASE instrument (this "Release").

I BELIEVE THAT MY CHILD IS QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN THE ACTIVITIES IN ANY CAPACITY. I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES ARE POTENTIALLY DANGEROUS ACTIVITIES AND INVOLVE THE RISK OF PERSONAL OR
PSYCHOLOGICAL INJURY, PAIN, SUFFERING, TEMPORARY OR PERMANENT DISABILITY, DEATH, PROPERTY DAMAGE, AND/OR FINANCIAL LOSS TO MYSELF, AND/OR MY CHILD. I ACKNOWLEDGE THAT ANY INJURIES THAT MY CHILD MAY SUSTAIN MAY RESULT FROM OR BE COMPOUNDED BY THE
ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE COMPANY, INCLUDING NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY. NOTWITHSTANDING THE RISK, I ACKNOWLEDGE THAT I AM KNOWINGLY AND VOLUNTARILY AUTHORIZING MY CHILD TO PARTICIPATE IN THE ACTIVITIES WITH AN EXPRESS UNDERSTANDING OF THE DANGER INVOLVED AND HEREBY AGREE THAT MY CHILD AND I ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE ARISING FROM MY CHILD’S PARTICIPATION IN THE ACTIVITIES, WHETHER CAUSED BY OR THAT MAY RESULT FROM THE NEGLIGENCE OF THE COMPANY OR ANY OTHER PARTICIPANT OR OTHERWISE TO THE FULLEST EXTENT PERMITTED BY LAW.

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Health Information
Do You Have Any of the Following: Required
Emergency Contact
Additional Information
How did you hear about us? Required

Everything on this form is true to my knowledge, and I have read and agree to the studio's terms & conditions.

Thanks for submitting!

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