HAVE YOU SEEN THE SPACE? (Print This Page, Sign, and Bring To The Space).
An extremely generous donation has been made to Long Island City, in the form of property being made available for activities specifically concerning the community. Called THE SPACE, many local artists, neighbors, and 
organizations have assisted in getting this situation ready, and we would like you to come visit. To enter the situation, 
THE SPACE requires this membership agreement and release of responsibility signed by the INDIVIDUAL, or INDIVIDUAL’S parent or legal guardian if under 18, basically securing the fact that the INDIVIDUAL is entering at 
their own risk and can and will not hold the donor’s in this situation, such as the property owner, the artists, and any representatives and employees that are associated with THE SPACE, responsible parties. Overall, this is a 
membership agreement, which commits membership and allows entry to THE SPACE’S property during specific times once signed by the INDIVIDUAL or INDIVIDUAL’S PARENT OR LEGAL GUARDIAN if under 18. 

The INDIVIDUAL shall be an independent member pursuant to this Agreement, and shall not be the agent, client, or employee of THE SPACE. 

As an independent member, the INDIVIDUAL shall be solely responsible for all insurance, as regards disability 
benefits, public liability and property damage or any loss incurred by your self, and hereby absolves THE SPACE and their representatives and employees. The INDIVIDUAL shall indemnify and hold harmless THE SPACE and discharges their representatives and employees, the property owner and its representatives and employees, from any and all claims, liabilities, expenses, damages or any causes of action directly or indirectly arising or resulting from or caused by the
INDIVIDUAL’S activity or lack thereof. 

Any cancellations of activities or programs shall be determined by THE SPACE. If either party is prevented from 
action because of Acts of God, strikes, illness or other causes beyond control, neither party shall be in breach of this agreement. 

THE SPACE shall have the right to record, by whatever means it desires, the activity of the INDIVIDUAL and shall 
retain all rights to use such a recording for any and all purposes of reproduction and/or distribution, without any compensation, financial or otherwise, made to the individual. This may include, but is not limited to, any form of reproduction and/or distribution in newspapers, magazines, television, and digital media format. 

This Agreement contains the entire agreement between the parties. No modifications or amendments thereof shall be of any effect unless made in writing and signed by both parties. The Agreement shall be covered by the city, local, and federal laws of the concerned property location. 
On behalf of THE SPACE, enjoy! 

Kristina A. Schopper (Kristy)
____________________________date:_______
SIGNATURE OF lNDIVIDUAL		 _____________________________________
SIGNATURE OF PARENT/LEGAL GUARDIAN 
(must be signed if individual is under 18) 
CONTACT INFO:(please print) 

name of individual: _________________________________ 
mailing address(please include city, state, and zip): 

_______________________________________________________________________ 

daytime phone: _____________________evening phone:______________________fax:_____________________ 

email address: ______________________________________ 
name of parent/legal guardian if individual is under 18: __________________________________ 

emergency contact: _______________________phone:_______________ relation:_______________________