To participate in any capacity other than an audience member or spectator at any Planet Ant event or program, individuals and organizations must agree to the following and complete the form below:


ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH PLANET ANT THEATRE, INC, their agents or employees, board of directors, officers, volunteers, participants, instructors, venues, venue staff and all other persons or entities acting in any capacity by through, under or on their behalf (hereinafter referred to as the Planet Ant), including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: PLANET ANT THEATRE INC. (Planet Ant) and/or their agents or employees, board of directors, officers, volunteers, participants, instructors, venues, venue staff and all other persons or entities acting in any capacity by through, under or on their behalf.

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that Planet Ant and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns, including use on social media.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.




Name *
Name
Phone *
Phone
Please identify any stage name, alias, or the official legal name of the organization that you represent.
My participation at Planet Ant is primarily (but not limited to): *
Please select the option that best describes your involvement at Planet Ant.
Please include the event title and date. (if you are purchasing a class, just enter "training center")
If you are representing an organization, do you have the authorization of said organization to enter in to contractual agreements in the name of said organization? *
Please check an option below to indicate your answer.
Required Forms *
Planet ant requires the submission of all required tax forms, as required by local, state, and federal law, to complete any type of payment. No payment will be issued without the receipt of a valid W9, for both organizations and individuals. Please email this form to forms@planetant.com.
Accident Waiver and Release of Liability Opt In *
Do you acknowledge that you have read, understand, and agree to the terms and conditions of Planet Ant's "Accident Waiver and Release of Liability" (found at planetant.com/release) *Opt in is required to participate in events, classes, and all other types of programming at Planet Ant.
If you have one, please enter your Instagram handle.
If you have one, please enter your facebook URL.
If you have one, please enter your website URL.
http://
Please enter a brief bio for yourself or your organization.
Please use this field to communicate any additional specifications, questions, comments, or concerns that you may have.
I, for this TERMS AND CONDITIONS FORM and ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM , warrant the truthfulness of the information provided in this form. Please type your name if you agree. This constitutes your digital signature.
*