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Atlan Center

SELF RESPONSIBILITY AGREEMENT

[WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNIFICATION AGREEMENT]


I, the undersigned person, in consideration of permission for myself, or any minor whose name appears below, to use Atlan trails, participate in Atlan or CultureSeed events, or to participate or volunteer in Activities (defined below) on Atlan land, I do agree on behalf of myself and any such minor/s, as follows:

  1. WAIVER. In consideration of permission to participate in any activity or event on Atlan managed land, which may include, but is not limited to, indoor and outdoor activities such as classes, workshops, presentations, meetings, dancing, personal retreats, retreats, camping, hiking, biking, horseback riding, yoga, trail use, outdoor activities, gardening, bath house use, sauna use, hot tub use, construction, woodworking, forestry, use of chainsaws and power tools, baking, fires, and related activities and equipment (together, “Activities”) I, on behalf of myself an any minor listed below, and our heirs, personal representatives, or assigns, DO HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Atlan LLC, a Washington limited liability company (“Atlan”), CultureSeed, a Washington nonprofit corporation (“CultureSeed”), and each of their directors, officers, members, beneficiaries, employees, volunteers, agents, representatives, sponsors, independent contractors, subcontractors, subsidiaries, and successors and assigns (“Protected Parties”) from any and all liability for any loss, damage, expense or injury, including death and loss of personal property, that I, my minor, or any parent or guardian or heirs and assigns may suffer, resulting from or arising out of any aspect of my or my minor’s participation in the Activities or use of related equipment or due to any cause whatsoever, including the ordinary negligence of Atlan, Culture Seed, or any of the aforementioned Protected Parties.

  2. ASSUMPTION OF RISK. I acknowledge that participation in the Activities and use of related equipment carry certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Some Activities, such as dancing, hiking, biking, gardening, construction, chainsaw use, power tool use, and participation in workshops can involve exertions of strength and can involve stress on the cardiovascular system. The Activities, can cause harm even when participated in properly. Specific risks associated with the Activities can range from: 1) minor injuries such as scratches, bruises, burns, and sprains, lacerations, and emotional turmoil; 2) major injuries such as concussions, broken bones, wildlife attacks, severed limbs, and heart attacks; to 3) catastrophic injuries including paralysis and death. I hereby freely agree to assume and accept any and all such risks of personal injury, death, property damage and loss associated with my participation, or my minor’s participation, in the Activities and use of the related equipment, including risks arising from conduct (either as a participant or spectator), the conduct of Atlan, CultureSeed or the Protected Parties, and the conduct of other participants.  

  3. INDEMNIFICATION AND HOLD HARMLESS. I also agree to DEFEND, HOLD HARMLESS, AND INDEMNIFY Atlan, CultureSeed, and the Protected Parties from any and all claims, law suits, demands, sums of money, causes of action, obligations and liabilities resulting from property damage, physical injuries, death, or mental injuries, relating to or in any manner connected with my participation, or my minor’s participation in the Activities and use of the related equipment, and to reimburse them for any expenses incurred as a result of my involvement.  

  4. ACKNOWLEDGMENT OF UNDERSTANDING AND VOLUNTARY PARTICIPATION. I KNOW THE NATURE OF THE ACTIVITIES AND USE OF RELATED EQUIPMENT, I UNDERSTAND THE DEMANDSof those Activities and use of related equipment relative to my, or my minor’s, physical condition and skill level, and I APPRECIATE THE TYPES OF INJURIES that may occur as a result. I HEREBY ASSERT THAT MY, OR MY MINOR’S PARTICIPATION IS VOLUNTARY AND THAT I KNOWINGLY ASSUME ALL SUCH RISKS. I HAVE HAD TIME TO READ THIS AGREEMENT and fully understand its terms. I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY AND MY MINOR’S RIGHT TO SUE. I acknowledge that I am signing this Agreement freely and voluntarily, AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY to the greatest extent allowed by law.

​Date: April 19, 2024

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Parent or Guardian's Email Address

Email*
Check to join Atlan’s Newsletter.
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
May your image be used in any Atlan Media?*
What's your primary purpose for filling out this waiver?*
Parent or Guardian's Signature*
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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