The Story School, Inc.
Risk and Media Agreement

This Risk and Media Agreement is used for those attending our In-person and Online Events. You MUST be 18 years or older to sign/submit this form. Attendees under the age of 18 must have their parent or legal guardian sign/submit this form.

All Fields Are Required To Complete Form

Participant Information

Participants Attending:
List the full name and age of each participant attending above that you are responsbile for
Use the enter or + button after each one is completed
Anyone wanting to enter the adventure room and activity must be listed here * 🛈

Date of the Event * +

	Emergency Contact Information
Name:	Emergency Contact Information
Relationship:	Emergency Contact Information
Phone Number:	Emergency Contact Information

The Story School offers an epic overnight summer camp and other events in-person and online. Check below to let us know if you are interested in learning more about our monthly events, school breaks, and summer camps *

Yes

Physical and Behavioral Accommodations

Do any of the above named participant require special accommodations or demonstrate any behaviors that could require adjustments to physical activities?

IE: Are they easily frightened by masks? Do they get upset easily if rules are broken? Do they get over-stimulated in physical activities? Have they hit things in anger? Do they have coping strategies for stress? Do they have any physical limitations? Do they suffer from epilepsy or any other condition that could make dark and mood lighting an issue? *

Yes

If yes, you/legal guardian must contact us immediately at (781) 214-1174 to discuss these behavioral concerns. Failure to have this discussion prior to the event may result in the above named not being allowed to participate in the event.
If no, please write 'none' in this field.
*

Communication Needs

All of our programs are presented in English, though we work hard to make our presentations very physical to allow for context clues. For the sake of making our events as streamlined as possible please answer the following question honestly, do any of the above participants have any issues understanding or speaking English? *

Participant has no issues with understanding or speaking English

Participant needs help understanding or speaking English

Participant is unable to understand English

Dress Code

All participants must wear clothing that is covering, comfortable, and safe for them to stand and move around *

I understand

Privacy Notice

PRIVACY NOTICE
In connection with your participation in the Event (which also includes, camps, classes, events and other services), we may collect information from you – both information you provide directly to us and information we otherwise collect during your participation in the Event and by your participation you consent and agree:

Information You Provide to Us: In order to participate in the Event, you will need to provide us with certain personal information, including your name, age, contact information and address. In addition, you may voluntarily provide us with other personal information.

Information We Collect: When you participate in the Event, we may collect other information from you, including, without limitation, payment information, your location at the Event and information collected as a result of using any Event-related electronic applications. The Released Parties may compile statistical and performance information related to the provision and operation of the Activities ("Aggregated Statistics"). All right, title and interest in the Aggregated Statistics and all associated intellectual property rights belong to and are retained solely by the Released Parties.

How We Use Your Information: We use the information described above for administering, marketing and promoting the Event, including, without limitation, advertising on social media and various magazine and print publications.

How We Share Your Information: We may share your information with certain third-party entities or individuals of our choosing, including, without limitation, service providers, affiliates, prospective business partners and/or contractors.

Waiver Agreement:
Please read the following before signing below

WAIVER FOR OFFLINE/IN-PERSON ACTIVITIES

This waiver is required by our insurance company. However, you should know that The Story School staff are trained extensively in running safe, entertaining, and educational classes and events. Our safety record is exceptional. Our staff work hard to keep participants safe and the swordplay at an acceptable level, but we acknowledge that accidents happen (someone may get hit in the head with a foam sword, trips and falls are common, collisions can happen from excited kids who aren’t looking where they are going, etc.).

We ask that you work with us to help embrace The Story School environment and activities with the understanding that participants who are active are at a higher risk of injury than those who are not. They are also at a higher risk of having more fun.

Definition: "Company" refers to The Story School Inc..

I understand that the above named will be held to a standard of conduct during this event. Failure to abide by safety rules will result in a warning or expulsion from the event without refund. I also understand that these events may include special effects and costuming that is considered frightening to some children. I also understand that the above named may learn, use, and be hit by a foam, foil, or practice weapon of some sort by other participants, staff, or themselves during this event. I also understand that the above named is personally liable for their own property they will be using during the course of their event. I further understand that the above named may be asked to engage in building and assembling items in their own space and accept the liability of injury or damage to self or personal property. I understand/have helped the above named to understand that I/they may decline to participate in any part of the event. I also understand that refusal to participate does not constitute grounds for refund of fee.

Media Release
I give the Company permission and consent for photos/videos to be taken of the above named during activities, and for these to be used for promotions in brochures, press releases, trainings, licensing, branding, and other media.

Risk Acknowledgment
By signing up the above named for this event, I acknowledge and understand that the participant will be voluntarily engaging in activities that may involve contact and the risk of serious injury, permanent disability, or death, and may cause severe social or economic losses due to not only the participant’s actions, inactions, or negligence, but also to the action, inactions, or negligence of others or conditions of the premises or of any equipment used. Further, I agree that I will not, nor will anyone acting on my behalf claiming by or through me, bring or maintain any suit in Court to assert any claim against the Company and/or any instructors/assistant instructors/staff for any claim that I might have arisen out of the above-named participation in any activities performed by, directed by, or endorsed by the Company or the instructors/assistant instructors. I agree to pay for any and all expenses (including but not limited to any medical expenses) that might relate to the participant’s care and treatment.

Print Your Name (person completing this form, either self or legal guardian) for Acceptance of This Waiver *

Legal Guardian Acknowledgement: *

I am the legal guardian OR am signing for myself and can legally sign for all participants

I am NOT the legal guardian

Waiver is void as the participant must sign their own name if over 18;

or the legal guardian must fill out the waiver.

Please contact a service representative

E-mail Address *

Electronic Signature Consent

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary. *

Please sign your full name with your mouse: *

clear

📖 The Story School, Inc 📖

📖 82 Leominster Road, Lunenburg, MA 01462 📖

📖 781-214-1174 thestoryschool.org 📖

The Story School, Inc. Risk and Media Agreement