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PARTICIPANT RELEASE OF LIABILITY and IMAGE RELEASE

YOU MUST READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the following related events and 


activities, I,

the undersigned, acknowledge, appreciate, and agree that: 

1. The risk of injury from the activities involved in any Energetic Movement Events provided by Energetic Movement, LLC staff includes, but is not limited to, the following; sprains, strains, falling, fractures, or any injury related to a physical exercise oriented activity. While the Energetic Movement system is designed to reduce this risk, the risk of injury does exist; and,


2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees, or others, and assume full responsibility for my participation; and,


3. I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, I observe any unusual significant risk during my presence or participation, I will remove myself from participation and bring such to the attention of the Energetic Movement, LLC staff; and,


4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless Energetic Movement, LLC, their officers, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, volunteers, and if applicable, owners and lessors of premises used to conduct the event ("Releasees"), with respect to any loss or damage to person or property, or any resulting arbitration costs whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law. This applies to the above stated entities and individuals while participating and/or working within the event’s parameters; including pre-event set-up and post-event break-down and any other event-related activities.


5. I further state that I am in proper physical condition to participate in this event and am over 18 years of age.


6. The Releasees reserve the right to postpone, cancel, or modify the event due to weather conditions or other factors beyond the control of the releasees, which might affect the health or safety of the participants.  Refunds will be considered, depending upon the factors involved.


7. I grant permission for the use of my name and or likeness related to my participation in any event conducted by Energetic Movement, LLC.  I also grant the use of my voice and any and all recorded and or filmed/video/photographed footage of me, and further waive all rights to any compensation, as a result of my name or likeness being used in any way.


I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.  I have also read and will comply with any additional facility and/or participant guidelines.

DOB
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