Event: Aerial/Dance (the “Activity”)
Participant’s Name (Please print): _______________________________ (the “Participant”)
Participant’s Age: _____________

I, for myself, my heirs, personal representatives or assigns, do hereby RELEASE, WAIVE, DISCHARGE, and COVENANT NOT TO SUE:

  1. Macy Cornerstone, LLC and its members;
  2. Fishbon and its board members, community members, and volunteers; and
  3. Autumn Phillips, Chanel Pepper, Adriana Llanes, Jeff Schultze, Henry Garibay, and affiliated participants.

Hereinafter referred to as “Hosts” from liability from any and all claims including negligence of the Hosts resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation
in The Activity.

Assumption of Risks:

Participation in The Activity carries with it certain inherent risks that cannot be eliminated
regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range

  1. Minor injuries such as scratches, bruises, and sprains
  2. Major injuries such as eye injury or loss of sight, serious cuts, joint, back, or spine injuries, broken bones, heart attacks, and concussions
  3.  Catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in The Activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD the Hosts HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my
involvement in The Activity and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement,
fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. The undersigned acknowledge that they are agreeing to the terms of this agreement freely and voluntarily, that its terms are
contractual, and not a mere recital, and intend by signing to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Signature of Participant                                                                     Date

__________________________________________ ____
Printed Name of Parent/Guardian of Minor       

__________________________________________ ____
Signature of Parent/Guardian of Minor                                         Date
(if Participant is under the age of 18)

Aerialist Agreement 

Name (Please Print):____________________

As a participant or observer in aerial/dance classes or open studios, I agree to the following:

  •  I understand aerial/dance is Dangerous!
  •  I will participate at my own risk!
  •  I will take the responsibility for managing my safety while using this facility.
  •  I assume all risk and responsibility for being in or using the aerial facility.
  •  I have read, understand, and signed the Waiver of Liability, Assumption of Risk, and
    Indemnity Agreement.
  •  I will pay for any damages I cause to the facility property or equipment.
  •  I will not teach anyone unless I have been cleared as an instructor by Autumn Phillips,
    regardless of my ability.
  •  I understand that any safety related instruction must be performed by approved staff.
  •  If I choose to use my own equipment, I take full responsibility of all consequences.
  • I will consult a physician if I have any question about my physical ability to climb or use the facility.


While using the Aerial Apparatus I will follow these guidelines/ rules:

  •  If I feel like I am stuck and/or might fall, I will HOLD ON and ask for assistance.
  •  I will wear fabric friendly attire when using the silks – No zippers, rivets, buttons, footwear, jewelry, or anything that can snag.
  • I will abstain from using the silks if I have an open wound, contagious illness, or contagious
    skin condition. Furthermore, I will be happy to seek out and provide a doctor’s note if any questions or concerns arise.
  •  I will share the fabric (and have fun!)


Signature:___________________ Printed Name:_________________ Date:__________

If Participant is under 18, the following must be completed by a Parent or Legal Guardian:
Signature:___________________ Printed Name:_________________ Date:__________

Emergency Contact Info:
Name:________________________________ Relationship:___________________
Home Telephone #:_______________ Cell #:__________________
Email: ____________________________