RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT

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IN CONSIDERATION of being permitted to participate in the activities and events of Axiom in Motion LLC, I, for myself, and for my personal representatives, assigns, heirs, and next of kin:

Please check box next to each statement below.

1.) Acknowledge, agree, and represent that I understand the nature of the activities of Axiom In Motion LLC, that these are physical in nature, and that I am qualified, in good health, and in the proper physical condition to participate in such activities. I understand the activities and events include running, climbing, jumping, vaulting, and other strenuous actions sometimes involving height, speed, and unpredictable surfaces. The activities and events require intense focus, awareness of my bodyʼs strengths and limitations, awareness of the environment around me, and extreme caution at all times. I understand that I must exercise good judgment at all times in order to remain safe, including stopping immediately if I feel lightheaded, faint, weak, or in pain. If at any time I feel I cannot continue to participate safely for any reason, whether because of a physical condition, the actions of myself or others, or any other reason, I must immediately discontinue involvement. As with any strenuous physical activity, I am aware that I must take any and all necessary precautions, including but not limited to seeking advice from my physician, prior to taking part in activities and events of Axiom In Motion LLC.

Required

2.) Acknowledge and fully understand that (a) activities involve RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH;(b) these Risks may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the conditions in which the activity takes place, or the negligence of the “Releasees” named below; (c) there may be other risk and social and economic losses either not known to me or not readily foreseeable at this time and I FULLY ACCEPT AND ASSUME ALL RISK AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in activities and events of Axiom In Motion LLC.

Required

3.) HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Axiom In Motion LLC, its administrators, directors, agents, officers, members, volunteers, and employees, other participants, sponsors, advertisers, and, if applicable, owner and lessors of the premises on which the activity takes place, (each considered one of the “Releasees” herein), from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations, and I further agree that if, despite this Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as a result of such a claim.

Required

Optional Photography and Video Release

I hereby authorize Axiom In Motion LLC to publish photographs and videos taken of me during my participation in any Axiom In Motion LLC classes or events, for use in Axiom In Motion LLC print, online, and video-based marketing materials, as well as other company publications. I hereby release and hold harmless Axiom In Motion LLC from any reasonable expectation of privacy or confidentiality associated with the images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs and videos, or participation in company marketing materials or other company publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Axiom In Motion LLC, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.

First Name of Participant *

Last Name of Participant *

Name of Parent/Legal Guardian (MINOR ONLY)

Address *

Emergency Phone Number *

Email *

SIGNATURE

By my typed name below, I affirm that I have read this agreement, fully understand its terms, and have completed it freely and without inducement of assurance of any nature, and intend it to be a complete and unconditional release of liability to the greatest extent allowed by the law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. Wisconsin law shall apply to this agreement.

Full Name *

AGREEMENT FOR MINOR PARTICIPANTS ONLY

The signatory-minor’s parent or legal guardian by evidence of signature above, understand the nature of activities and events of Axiom In Motion LLC and also understand the Minor’s experience and capabilities and understand that the Minor is in good health, and in proper physical condition, to participate in Axiom In Motion LLC activities and events.
A parent/Legal Guardian, the checkbox below, agrees on behalf of the Minor and himself/herself to the terms of the release set forth hereinabove.

I release the Minor

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