Moco Arts Liability Release printable pdf download

MoCo Arts Liability Release

Student’s Name ________________________________________________________________

I, ______________________________, for and in consideration of being allowed to participate in

MoCo Arts programs, do hereby agree to release MoCo Arts and its agents, employees, successors and

assigns from any and all liability for property damage, personal injury, or death to myself or any other

person or property, resulting from the negligence of MoCo Arts, or its agents or employees.

I understand that the activities I will engage in while I am participating in MoCo Arts programs involve

a risk of injury. I release MoCo Arts and its agents, employees, successors and assigns from any and all

liability for property damage, personal injury, or death to myself or any other person or property,

resulting from or associated with the risks inherent in my participation in any MoCo Arts program.

I am aware of my personal medical needs and condition. I represent that there are no health related

reasons, physical or psychological impairments or problems that, in the exercise of reasonable care,

would preclude or restrict my participation in the MoCo Arts programs for which I have enrolled, or

would put myself or others in danger by my participation.

I acknowledge that I have carefully read this Release, and I understand and accept its terms. I understand

that my signature on this Release means that, in consideration of my acceptance and participation in

MoCo Arts programs, I fully accept all risks related to my participation in MoCo arts programs.

_________________________________________

Student’s Name (if student is over 18)

_________________________________________

Students Signature (if over 18)

_________________________________________

Parent/Guardian’s Name (if student is under 18)

_________________________________________

Parent/Guardian’s Signature (if student is under 18, signing on behalf of the student)

If you have any questions, please contact MoCo Arts by phone, (603) 357-2100, or by email,

, or through the comment form found on our website

Transforming Lives Through Movement & Creative Expression

76 Railroad St.

Keene, NH 03431

(603) 357-2100

Moco Arts Liability Release