Please fill out the form below to acknowledge and agree to the terms listed in theCirque Party Liability Waiverand/or theCirque Party Media Release Name * First Name Last Name Email * Name(s) of your child(ren) participating (if applicable; separated by commas) Liability Waiver * I agree Media Release * *Please note that for insurance purposes, Cirque Party is required to set up video surveillance for the duration of the event. There will be a small video camera attached to the aerial rig. The video feed is not broadcast anywhere and is only recorded locally onto the camera’s memory card and stored for insurance records. Footage of you / your child will NOT be used on any media platform if you select the media opt out option. Yes, I consent to be in Cirque Party media No, I do not consent and would like to opt out of media If you opted out of the Media Release, please let us know what you / your child are / will be wearing at your Cirque Party event, or any other identifying markers we can look for to ensure we do not include images or videos of you / your child: * (type N/A if you consented to the Media Release) Date Signed * MM DD YYYY Keep me posted about future events! * Yes please! No thanks Thank you for completing the Cirque Party Liability Waiver and Media Release forms - we hope you enjoy your event!If you’re submitting this live at a Cirque Party event, please show this post-submit message to our Cirque Party crew to get your stamp and participate!Visit our website to learn more! Slide 1 Slide 1 (current slide) Slide 2 Slide 2 (current slide) Slide 3 Slide 3 (current slide) Slide 4 Slide 4 (current slide) Slide 5 Slide 5 (current slide)
