CRT WAIVER AND ASSUMPTION OF RISK

The undersigned, ________________________________ (participant/member), voluntarily makes and

grants this Waiver and Assumption of Risk in favor of Castaways Repertory Theatre/Prince William
County Parks Authority, Prince William County Arts Council (Organization) as partial consideration (in
addition to monies paid to Organization) for the opportunity to use the facilities, equipment, materials
and/or other assets of Organization; and/or to receive assistance, training, guidance, tutelage and/or
instruction from the personnel of Organization; and/or to engage in the activities, events, sports, festivities
and/or gatherings sponsored by Organization; I do hereby waive and release any and all claims whether in
contract or of personal injury, bodily injury, property damage, damages, losses and/or death that may arise
from my aforementioned use or receipt, as I understand and recognize that there are certain risks, dangers
and perils connected with such use and/or receipt, which I hereby acknowledge have been fully explained
to me and which I fully understand, and which I nevertheless accept, assume and undertake after inquiry
and investigation of extent, duration and completeness wholly satisfactory and acceptable to me.
I further agree to use my best judgment in undertaking these activities, use and/or receipt and to faithfully
adhere to all safety instructions and recommendations, whether oral or written. I hereby certify that I am a
competent adult assuming these risks of my own free will, being under no compulsion or duress. This
Waiver and Assumption of Risk is effective from July 1, ____, to June 30, ____, inclusive, and may not
be revoked, altered, amended, rescinded or voided without the express prior written consent of
Organization.

Printed Name________________________________ Date _______________________________

Signature____________________________________ Age _______________________________
Parent/Guardian______________________________

CRT AUTHORIZATION OF RELEASE

I hereby irrevocably grant to the Castaways Repertory Theatre (herein CRT) and any parent, subsidiary
and affiliated corporations and their respective successors, assigns, licensees, employees and agents, the
right in perpetuity throughout the universe, and in all now known and hereafter existing media, and in any
language, to use my name (including any fictitious names heretofore or hereafter used by me), physical
likeness and/or voice in and in connection with the production, exhibition, exploitation, merchandising,
advertising and promotion of CRT and/or the production entitled _____________________________. I
agree that the foregoing grant includes the right to use my physical likeness in any form, including,
without limitation, a photograph, picture, artistic rendering, silhouette or other reproduction by
photograph, film, tape, or otherwise. I represent to the best of my knowledge that the consent of no other
persons, firm corporation or labor organization is required to enable CRT to use my name, likeness and/or
voice as described herein and that such use will not violate the rights of any third parties. I hereby certify
and represent that I am over 18 years of age or have parental/guardian consent and have read the
foregoing and fully understand the meaning and effect thereof.

Printed Name________________________________ Date _______________________________

Signature____________________________________ Age _______________________________
Parent/Guardian______________________________