Please print, sign and turn in this form at your first class at the Brave New Institute. Thank You!

I, the undersigned, am a willful participant in a Brave New Institute program as a student and/or volunteer performer. I understand that improvisation and theatre classes and performances include physical activities that may involve physical exertion, unexpected movements and contact with other participants. I understand that the physical and creative nature of these classes and performances may at times put me at risk for accidental injury, and I voluntarily accept that risk. I agree that I will not hold the Brave New Institute, Brave New Workshop, Into the Mystic Productions, its teachers, its employees and its volunteers liable for any injury that I may incur on or near the premises of the Brave New Workshop or Brave New Institute in connection with my participation in these programs. I understand that activities and exercises which may be considered to be normal and expected activities of participation in Brave New Institute/Brave New Workshop improvisation and acting programs, which may result in injury, include, but are not limited to: vigorous and random physical movement on and around stages and chairs; vigorous vocal exercises; vigorous and random contact with other participants; and/or physical exertion that mat heighten or exasperate a pre-existing physical condition that I may have. I am fully aware of these risks and understand that I am responsible for monitoring myself in a way that does not put others or me at undue risk. I understand my right to discontinue participation at any time if I feel a certain activity puts me at undue risk, and that such a decision will not affect me in any negative way as a participant in these programs.

Signature of participant

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Printed name of participant

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Date of signature ___________________________________

EMERGENCY CONTACT INFORMATION

Name of Contact

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Phone Numbers ______________________________________

Any allergies or pre-existing medical conditions you would like us to
be aware of (use back if necessary):

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