Age of Participant *

What is your main interest in this event? *

Warning: by electronically signing this form you give up important legal rights including the right to sue. Please read carefully. *

Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement Definitions: In this document: “The Event” refers to the Madskillz Vancouver Society, Madskillz 10 / Van Jam 6 Festival, taking place August 16-17, 2019 at the Roundhouse Community Centre; “Festival Activities” include any and all Festival sanctioned activities, practice sessions, open gym time, workshops, social functions, competition and performances; “The Crew” refers to the Madskillz Vancouver organizing committee, their officers, agents, contractors, employees, vendors, coaches/instructors, trainers, volunteers and representatives. *

Description of Risks: In consideration of my participation in the Festival Activities, I acknowledge that I am aware of the possible risks, dangers and hazards associated with my participation in the festival activities, (including the possible risk of severe or fatal injury to myself or others). These risks include but are not limited to the following: a) all manner of injuries including but not limited to bruises, scrapes, burns, broken bones, cuts resulting in muscular injuries and soft tissue injuries, etc., from executing strenuous and demanding physical techniques, collisions with other participants, falling and impacting against the floor, walls, apparatus/equipment or ground, and failure in proper use of the equipment or techniques either by myself or other participants including but not limited to juggling clubs, balls, hula hoops, kendama, poi, unicycles, rubber chickens, flaming torches, knives and other sharp objects, diabolo, devil sticks, and flaming objects; b) all manner of head, facial, eye and/or dental injuries; c) increased risk of injury resulting from a crowded environment; d) increased risk of injury as I become fatigued, experience pain, frustration, humiliation and/or performance anxiety; e) the potential risk of experiencing episodes of light-headedness, fainting, chest discomfort, leg cramps and nausea; f) the potential risk of an increased load on the heart, which may result in dizziness, shortness of breath and in extreme circumstances, may result in a heart attack; g) all manner of injuries and/or death that could result from a physical confrontation whether caused by myself or someone else; h) all manner of injuries and/or death that may result from transportation (all modes or types) incidents/accidents to and from Festival Activities. *

Disclaimer Clause: The Crew is not responsible for any injury, loss or damage of any kind sustained by any person participating in any and all Festival Activities, including injury, loss or damage which might be caused by the negligence of the Crew *

In consideration of the Crew allowing my participation in Festival Activities, I agree as follows: 1. To assume and accept all risks arising out of, associated with, or related to my participating in the Festival Activities, even though such risks may have been caused by the passive or active negligence of the Crew; 2. To waive any and all claims that I have or may have in the future arising out of, or associated with or related to my participating in the Festival Activities; 3. To release the Crew from any and all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the Festival Activities due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care; 4. To hold harmless and indemnify the Crew from any and all liability for any damage to the property of, or bodily injury to, any third party, resulting from my participation in the Festival Activities. *

Medical/Health & Travel Insurance 1. I am solely responsible to select and purchase adequate medical/health insurance. No medical/health insurance will be provided by the Crew. In the event of a medical/health problem, the Crew accepts no responsibility for any costs associated with a medical/health problem, nor will they pay for any medical/health expenses, which may be incurred by participation in Festival Activities. 2. I am solely responsible to select and purchase adequate travel insurance when and if required. The Crew will provide no travel insurance. The travel insurance should provide cover against theft, personal accident, personal liability, repatriation and cancellation of tickets. The Crew accepts no responsibility for any costs associated with these types of problems nor will they pay for any expenses that may be incurred by my participation relating to these areas. *

Acknowledgement *

Today's Date *