Contact Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.I will be participating in the event "Body Painting at ChaShaMa Gala" produced by Human Connection Arts, Inc. (HCA), taking place on June 20th 2024. I hereby irrevocably consent to and authorize the use and reproduction by HCA of any and all photographs, video and audio footage that HCA or anyone authorized by HCA has taken of me or of my art for any purpose whatsoever without compensation to me. All such photographs, video and audio footage recorded during the Human Canvas painting shall constitute the property, solely and completely, of HCA. I certify that I am over 18 years of age. *I agreeI do not agreeI fully understand and hereby assume all of the risks and dangers by participating in this event. I participate willingly and voluntarily and assume full responsibility for any personal injury occurring as a result of any accident that may occur. I specifically understand that I, my personal representatives and my heirs are releasing, discharging and waiving any claims, actions, and losses for bodily or psychological injury, property damage, wrongful death, loss of services, or otherwise, that I may have presently or in the future, for any negligent acts or other conduct by HCA, its directors, officers, volunteers, representatives and agents. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. *I agreeI do not agreeI understand that this is a full nude body painting performance. There are 2 parts to the evening; Chashama Gala from 6-9pm and the Chashama Art Party from 9pm-1am. I understand that I need to arrive by 5pm and will model until at least 11pm. After 11pm, I am free to stay, leave, or stay and get dressed. *I agreeI do not agreeName *FirstLastEmail *Today's DateSubmit