問診票
1、過去6時間以内にアルコール、薬等 乗り物の運転に危険とされる物を摂取していません。
2、医師等に運動を止められていません。
3、腕、肩、首、脊椎、腹部等にある程度のプレッシャーがかかることを理解しております。
４、インストラクター、もしくはTrapeze Heroes関係者の指示に従わなかったり、許可なく設備等を動かしたりすると重大な危険を自分、もしくは他者に与えてしまう可能性があることを理解しています。
5、空中ブランコでの運動はTrapeze Heroesがいかに安全に気を配ろうともある程度の危険は払拭しきれないことを理解しています。私達ははあなたに対し提案はしますが最終決定権はあなたにあり、あなたの決定に対して自己責任を負っていただきます。
６、Trapeze heroes で、撮影された動画、映像、写真は、公序良俗に反しない範囲で宣伝、サンプルに使用させていただきます。問題がある場合は対応致しますので申告下さい。
７、Trapeze Heroesの敷地内での盗難、レッスン外での事故（例、車同士の接触事故や歩行者への接触など）の責任は一切負えませんので自己管理を徹底してください。
８、当施設にゴミ箱は用意していません。お持ち込み頂いた物はお持ち帰り頂きますようお願い致 します。
９、Trapeze Heroes、インストラクター、スタッフ等に重大な過失がない限りいかなる法的手段を行使する権利を放棄いたします。覚書への署名をもって問診票の説明を受け理解し、承諾したことの証といたします。
THE AGREEMENT, RELEASE, and ASSUMPTION of RISK
In consideration of the services of Trapeze Heroes, and its agents, owners, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “Trapeze Heroes”), I hereby agree to release, indemnify and discharge Trapeze Heroes on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I have not been under the influence of alcohol, drugs, or any other substance which has an effect on driving within the past 6 hour
2. I have not received a doctor’s restriction on participating in physical activities.
3. I understand that this activity will incur pressures on my arms, shoulders, neck, spine, abdomen, and other body parts.
4. I understand that if I do not follow the instructions or use the equipment without my instructors’ permission, it may result in a serious accident for myself or others around me.
5. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in flying trapeze is purely voluntarily, and I elect to participate in spite of the risks.
6. I understand that videos and photos are captured during the activity may be used as advertising or as an exemplar within an allowance the public orders and morals. If I do not what Trapeze Heroes to use videos and photos with my image, I will tell the instructor RIGHT NOW.
7. I understand that Trapeze Heroes does not take responsibility or liability for theft on their property or any accident outside of activity hours. (For instance, car accident, accidental contact with a pedestrian...etc.)
8. I am responsible for disposing of my own trash.
9. By signing this document, I acknowledge that if anyone is hurt or property is damaged during participation in this activity, I waive my right to maintain a lawsuit against Trapeze Heroes on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.