2024-2025 Civinettes Guest Liability Waiver

2024 Civinette Event / Liability Waiver

TO BE FILLED OUT BY THE GUEST/DATE OF A CIVINETTE. EACH GUEST/DATE REQUIRES GUEST AND PARENT SIGNATURES ON WAIVER.
Guest Last Name*
Guest First & Last Name*

First NameLast Name
Guest Date of Birth*

MonthDayYear
Date
Guest Phone #*
Please enter a valid phone number.
Guest School*
Responsible Parent/ Legal Guardian Name*

First NameLast Name
Parent / Legal Guardian Contact Number*
Please enter a valid phone number.
Name of your Civinette Date

First NameLast Name

Another Emergency Contact (over 21 years of age and different than parent contact listed above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

2024/25 Madison Junior Civitan Liability Waiver Form
CIVINETTE DANCE RULES:

1. All CIVINETTES IN GOOD STANDING ARE ALLOWED TO ATTEND THE EVENT & BRING ONE GUEST TO THE EVENT. All attendees (both Civinettes and Guest) must have a signed Madison Junior Civitan Club Liability Waiver Form (“Form”) turned in and abide by these guidelines.

2. Any guest attending the dance must be a under 20 years of age.

ADMITTANCE AND ATTENDANCE. Admittance is subject to approval of the advisory board. Note: Permission to attend the dance is a privilege, not a right, and may be revoked at any time by the advisory board in its sole discretion.

3. All attendees must bring a valid STUDENT ID and/or Drivers License for admittance.

4. Any attendee must be willing to submit to alcohol and or drug testing, including a random breathalyzer test before entering the dance. Refusal by any attendee to submit to such testing shall result in the immediate ejectment of such attendee.

5. Any attendee or guest consents to being searched for weapons and illegal substances prior to or following admittance into the event.

6. Any attendee or guest who leaves during the dance will not be readmitted.

7. All attendees and guests not driving must be picked up no later than 10:30 p.m.

I agree to the dance rules #1-#7
Please Check One*

I agree to abide by the dance rules #1 to #7 aboveI do not agree.

GENERAL RULES 1. All Madison Junior Civitan Club rules/bylaws and the established rules expectations outlined in this document are in force during the dance. 2. Any attendee or guest suspected of using Alcohol / Drugs / E-Cigarettes/ Vaping / Juuling or any controlled or illegal substance prior to or during the dance will be removed from the dance. Parents will be called to escort the person home. Using tobacco at Civitan events is strictly prohibited. Any attendee suspected of using alcohol or any controlled or illegal substance prior to or during the dance or tobacco during the dance is subject to immediate ejectment and criminal charges. 3. Guests are required to abide by all rules, including those outlined in this document. Any student or guest choosing not to do so will be removed from the dance. The student’s parent(s) will be notified, and the police will be notified should such notification be warranted.

DANCE CONDUCT: Attendees are expected to dress and behave in ways that are appropriate. Attendees are expected to behave appropriately on the dance floor. No refund will be given to attendees or guests who are asked to leave the dance. All Dance attendees must obey the rules of the facility. Be respectful to Chaperones.

DRESS CODE: Violations may result in non-admittance. If dress code violations occur after admittance, the ATTENDEE and/or guest may be removed from the dance.

ATTENDEES: FEMALE: All Long, Short Dresses and any costume themed event attire should maintain the integrity of our club dress code and not convey ANYTHING or inappropriate or vulgar. Dresses are not to have bare midriffs.. Undergarments should not be visible. No see-through clothing. B. All necklines must be modest and in good taste. NO DEEP V FRONT, MUST HIT NATURAL BRA LINE. NO LOW BACKS, MUST HIT NO LOWER THAN 2 INCHES BELOW NATURAL BRA LINE, No excessive cleavage. Strapless dresses are permitted. C. Two-piece dresses are allowed with no more than 1.5 inches of stomach skin showing. D. Any other attire deemed inappropriate by the advisory board will not be permitted.

MALE ATTENDEES: SUIT/DARK COLORED PANTS or TUXEDO is appropriate for formal and masquerade ball and any costume themed event attire should maintain the integrity of our club dress code and not convey ANYTHING or inappropriate or vulgar.
BREATHLYZER TEST SUBMISSION: Attendee is willing to submit to alcohol and or drug testing, including a random breathalyzer test before entering the dance. I understand refusal by any attendee to submit to such testing shall result in the immediate ejectment of such attendee.
PARENTS PLEASE SIGN BELOW: I understand the breathalyzer policy. Please sign. Parent Signature below.*

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GUEST/DATE SIGN BELOW: I understand the breathalyzer policy. Please sign. Guests Signature below.*

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Participant Waiver/ Assumption of Risk
Participant Waiver, Release PLEASE READ CAREFULLY AND DO NOT SIGN BEFORE HAVING FULLY READ AND UNDERSTOOD ALL OF THE FOLLOWING TERMS. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS AND IS LEGALLY BINDING.

BY SIGNING THIS AGREEMENT YOU ARE FULLY, FINALLY AND IRREVOCABLY RELEASING THE MADISON JUNIOR CIVITAN CLUB, AND ALL OF ITS ADVISORS AND CHAPERONES (collectively referred to as “CLUB/CHAPERONES/ADVISORS”) FROM ANY AND ALL CLAIMS AND/OR LIABILITY OF ANY NATURE ARISING OUT OF OR OTHERWISE RELATING TO ANY EVENT HELD, SPONSORED OR PROMOTED BY THE MADISON JUNIOR CIVITAN CLUB, OR ANY EVENT OTHERWISE OCCURRING AS A RESULT OF OR IN CONNECTION WITH ASSOCIATION WITH THE MADISON JUNIOR CIVITAN CLUB AND/OR ANY OF ITS MEMBERS.

Assumption of Risk -- I, in my legal capacity as parent/legal guardian of a minor (“Minor”), acknowledge and agree that any PARTICIPATION IN any Madison Junior Civitan Club Sponsored Event & Service Project comes with inherent risks including, but in no way limited to: (1) moderate and severe personal injury, (2) property damage, (3) disability, (4) death, and (5) sickness or disease. I voluntarily, for myself and Minor, accept and assume full responsibility for these risks as well as any and all other risks of the use of any facility and participation in any Madison Junior Civitan Club Sponsored Event & Service Projects (collectively referred to as "EVENTS") . I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document.

Waiver, Release, Indemnification & Covenant Not to Sue -- In consideration of Minor’s use of Facilities and participation in Events, I, in my legal capacity as parent/legal guardian of Minor, agree on behalf of myself and Minor that CLUB/CHAPERONES/ADVISORS, and their insurers and representatives (collectively referred to as “Releasees”) shall in no way be liable for any personal injury, property damage, disability, death, sickness or disease incurred by Minor, however occurring including, but not limited to, the negligence of Releasees. I understand that Minor and I will be solely responsible for any loss or damage, including personal injury, property damage, disability, death, sickness or disease sustained from the use of Facilities and participation in any Madison Junior Civitan Club Sponsored Event & Service Project. I further agree, in my legal capacity as the parent/guardian of Minor, on behalf of Minor, myself, and any and all legal successors and proxies, to release and HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releasees from any causes of action, claims, suits, liabilities or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which Minor, myself, and any and all legal successors and proxies may have, now or in the future, against Releasees on account of personal injury, property damage, disability, death, sickness, disease or accident of any kind, arising out of or in any way related to EVENTS, whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to, the negligence of Releasees.

I, in my legal capacity as parent/guardian of Minor, agree on behalf of myself and Minor to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, suits, liabilities or costs of any nature whatsoever, including claims of negligence, arising out of or in any way related to the use of Facilities , PARTICIPATION IN EVENTS and DRIVING OR TRANSPORTATION TO AND FROM EVENTS. I am responsible for any damage caused to the facility by my child.

I understand the Madison Junior Civitan Club rules and I have read and understand the established rules and guidelines given to me for the dance and agree to abide by them. I understand the consequences for any inappropriate behavior. I understand that if I am asked to leave the dance for not following these rules and/or the established expectations for the dance. I also understand that the dance is a Madison Junior Civitan Club event and is tobacco, drug and alcohol free.
Responsible Parent / Legal Guardian Email*
example@example.com
Parent / Legal Guardian Signature*

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Guest/ Date Signature*

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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.
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2024 Civinette Event / Liability Waiver

2024/25 Madison Junior Civitan Liability Waiver Form

Participant Waiver/ Assumption of Risk