Waiver, Media Release, and Consent

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Member Name *

First

Last

Email *

Phone Number *

Waiver: In the event I am injured or suffer any short-term, long-term Physical harm or death, by signing below, I release Kontagious Performing Company, Kontagious Performing Company LLC, its extension teams and affiliates: Kontagious, Kure, Toxik, Angels, Sick, Lynnwood Recreation Center, Exit Space, The Nest, and any additional locations and/or its organizers, promoters, instructors and participants from any and all liabilities now or in the future including but not limited to medical, dental, hospital, paramedic or ambulatory care.

Media Release: I agree to being videotaped and photographed. I understand that this footage may be shared with the general public in various types of media (television, ads, internet, etc.). I will allow Kontagious Performing Company, Kontagious Performing Company LLC, extension teams and affiliates: Kontagious, Kure, Toxik, Angels and Sick to use this content for marketing and advertising purposes related to the website and the promotion of the company. I am at least 18 years of age. If not, I have parent/ guardian knowledge and consent of my participation.

Dancer E-Signature *

Parent/Guardian E-Signature *

BY SUBMITTING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND AGREE TO THE KPC WAIVER, MEDIA RELEASE, & CONSENT/AGREEMENT SHOWN ABOVE.

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KPC Waiver, Media Release, & Consent/AGREEMENT