Registration
Already a customer? Click here to login.
You may have seen the dancing wall in our circus barn or watched awesome videos of people dancing on the side of buildings. Well now you can try out this crazy cool form of vertical dance. This class will cover some basics of working in a harness and learning a choreography on a horizontal surface. No experience required.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
StepParent
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
We will need to know your hip/waist measurements for harness sizing. What are your hip/waist measurements?
*
Additional Information:
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
(Show-Hide Details)
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
In consideration of the services of Kinetic Tapestry Physical Theatre, Inc., their agents or employees, owners, officers, volunteers, participants, and all other persons or entities acting in any capacity by, through, under or on their behalf (hereinafter collectively referred to as "KTPT"), I hereby agree to release, indemnify, and discharge “KTPT”, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that my participation in instruction and training, individual and group initiatives, problem solving exercises, personal growth and development exercises utilizing static trapeze, trampoline, silks, lyra, Spanish web and vertical rope entails known and unanticipated risks that could result in physical or emotional injury or death. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: the hazards of slips and falls; falling from equipment; equipment failure; collision with fixed objects or people; rope burns; muscular strains and tears, fractured bones, bruises, cuts, organ damage, nerve damage, head, neck and back injuries; scratches, bruises, sprains, lacerations, or even more severe life threatening hazards; psychological damage; dehydration; permanent disability; the possibility of eye damage or loss of hearing; the failure to work out safely or within one’s own ability or within designated area; the negligence of other participants or persons who may be present; being struck by objects dislodged or dropped from above; the risks of falling off the trapeze and other aerial apparatus; my own physical condition, and the physical exertion associated with this activity.
Furthermore, KTPT employees have difficult jobs to perform. They seek safety, but they are not infallible and among other things (1) they might be unaware of a participant's fitness or abilities, (2) they may give incomplete or inaccurate instructions or warnings, and (3) the equipment being used might malfunction. (INITIAL)
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. (INITIAL)
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless KTPT from and against any and all claims, demands, actions, suits, judgments, damages, liability, cost or expense, or causes of action, which are in any way connected with my participation in any activity at KTPT or my use of any KTPT equipment or facilities, including but not limited to those alleging negligent acts or omissions. (INITIAL)
4. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. (INITIAL)
5. Should KTPT or anyone acting on their behalf, be required to incur reasonable attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. (INITIAL)
6. Notwithstanding anything to the contrary herein, if I file a lawsuit against KTPT, I agree to do so solely in the state of Missouri, and I further agree that the substantive law of Missouri shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect. (INITIAL)
By signing this document, I acknowledge that if anyone is hurt, or property is damaged or lost during my participation in this activity, I waive my right to maintain a lawsuit against KTPT on the basis of
I've read the above and agree.
Photo Release Waiver
(Show-Hide Details)
I give full rights to Kinetic Tapestry Physical Theater and its staff to use photos and video images of me and/or my child to use for promotional purposes of Kinetic Tapestry Physical Theatre only. Photos and video will be used in brochures, websites, advertisements, social media, and other promotional material created by the studio. Photos may appear with or without names in press releases and other print advertising. I further understand no financial compensation will be for use of these photos/videos.
I've read the above and agree.
PARENT’S OR LEGAL GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Show-Hide Details)
Must be completed for participants under the age of 18. This is to certify that I, as the parent or guardian with legal responsibility for the Participant, do consent and agree to his/her release as provided above. I understand that a minor may not be left unaccompanied at the facility unless attending a day camp program. In consideration of the Participant’s being permitted by KTPT to participate in its activities and to use its equipment and facilities, I release and agree to indemnify and hold harmless KTPT, to the fullest extent permitted by law, from any and all liability, claims which are brought by, or on behalf of Participant, even if such liability arises from the active or passive negligence of KTPT. (INITIAL)
I've read the above and agree.
Covid19 Liability Waiver
(Show-Hide Details)
Kinetic Tapestry’s COVID-19 Liability Waiver
In consideration of the services provided by the facility, their agents, owners, officers, volunteers, participants, employees, independent contractors, volunteers, interns, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "Releasees"),
I represent that I am in good health and have had no known exposure to COVID-19 and no symptoms of COVID-19, including Cough, Shortness of breath or difficulty breathing, Fever, Repeated shaking with chills, Muscle pain, Headache, Sore throat, New loss of taste or smell, for 14 days prior to attending the facility. I acknowledge that if I believe I have had any exposure to COVID-19, I will immediately cease attendance at the facility until I can again warrant that I have had no known exposure for the 14 day period and alert the facility if I
have been on the premises since my exposure.
The facility is making its best efforts to reduce the risk of transmission of COVID-19. But the safety of the community is in the hands of every one of us. I expressly agree and promise to abide by the safety precautions CONTAINED IN: Reopening Guidelines.
I am aware that training during and after the COVID-19 pandemic involves certain inherent risks, dangers and hazards, which can result in serious infection, personal injury or death. I further acknowledge, understand, appreciate, and agree that my participation may result in possible exposure to and illness from COVID-19. While protocols and personal discipline may reduce this risk, the risk of serious injury, illness, and even death is not possible to fully mitigate.
I hereby freely agree, to assume and accept all known and unknown risks of exposure to COVID-19, even arising from the negligence of the releasees or others and assume full responsibility for my participation. I further recognize and acknowledge that the risks
inherent in training can be greatly reduced by following CDC guidelines such as hand washing, not touching your face, keeping 6 feet social distance.
I hereby waive, release, and discharge all claims that I have or may have in the future, and covenant not to sue your business, its administrators, directors, agents, officers, volunteers, employees, contractors, other participants, any sponsors, advertisers, owners, and lessors of the premises on which the activity takes place (each considered one of the "releasees" herein)
from all liability, claims, demands, losses, 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.
I further agree that if, despite this release, waiver of liability, and assumption of risk, I or anyone on my behalf makes a claim against any of the releasees, I will indemnify, defend, and hold harmless each of the releasees from any loss, liability, damage, or cost, including attorneys' fees, which any of the aforementioned may incur as a result of such a claim.
I accept for use as-is the equipment to be used in activities governed by this agreement.
This Agreement, and all claims or causes of action (whether in contract, tort or statute ) that may be based upon, arise out of or relate to this Agreement, or the negotiation, execution or performance of this Agreement (including any claim or cause of action based upon, arising out of or related to any representation or warranty made in or in connection with this Agreement or as an inducement to enter into this Agreement), shall be governed by, and enforced in accordance with, the internal laws of the State of MIssouri, including its statutes of limitations and without regard to its choice of law principles. The undersigned herein irrevocably consents to the jurisdiction of the courts in Missouri, which shall be the sole forum for the resolution of any disputes that arise out of or relate to the parties' relationship.
The partie
I've read the above and agree.
Covid19 safety partnership agreement
(Show-Hide Details)
The Safety Partnership Agreement is between Kinetic Tapestry Physical Theatre and this student or their parent(s)/legal guardian(s). Each time you are coming into Kinetic Tapestry’s Circus Barn, you agree to the following:
To the best of my knowledge, I/my child:
Have not shown symptoms of COVID-19 in the past 14 days. According to theCenter for the Disease Control, below are symptoms:
?Cough
?Shortness of breath or difficulty breathing
?Fever
?Repeated shaking with chills
?Muscle pain
?Headache
?Sore throat
?New loss of taste or smell
Have not been in contact with anyone who has tested positive for COVID-19 or shown any of the above symptoms in the past 14 days.
Understand that I could be a carrier of COVID-19 and be asymptomatic.
Understand that I could contract COVID-19 from an asymptomatic person at our facility or a contaminated surface.
Am fully aware of the facility's safety procedures (posted on our website and our studio wall) to prevent the spread of COVID-19 and will follow these procedures.
Agree to inform the studio/school immediately if I have developed symptoms within a two week period of being in the studio, or if I have learned that I have been in direct contact with someone who has later tested positive for the coronavirus within the same two week period.
Understand that if I willfully and intentionally violate the stated hygiene rules in our facility, the facility has the right to suspend me without a refund.
Agree to inform the studio/school immediately if I learn that any of the above information changes or I obtain new information.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Please Wait...
