RELEASE OF LIABILITY
You are required to read the following information very carefully and make sure that you understand it fully and sign it before you participate in this activity or program:
We, Throwing Tantrums LLC., (“Company”), are a mobile rage room. We will be setting up a tent providing safety equipment and allowing people to smash glass (“activity”). The activity will take place on [ENTER DATE].
By signing this Waiver, I, [ENTER NAME], expressly assume all risk of myself participating in the above activity. Without signing this form, I will not be able to participate in the activity. I acknowledge that the above activity may pose some risk of personal injury and that I undertake and assume this risk for myself.
On behalf of myself, I further waive and release the company, promoters of the activity, any insuring entity of the above, and their directors, board members, officers, employees, volunteers, agents, representatives, or assigns, as well as the activity sponsors, from any and all liability, including, but not limited to, liability arising from negligence or fault of the entities or persons for any injury or disability which may occur as a result of my participation in the above activity. I am assuming all risks on behalf of myself that may arise from negligence or carelessness on the part of any of the persons or entities being released, as well as from defective equipment, real property or personal property that is owned, maintained or controlled by the above persons.
I CERTIFY THAT I AM PHYSICALLY FIT AND SUFFICIENTLY PREPARED FOR PARTICIPATION IN THE ACTIVITY AND THAT THERE ARE NO HEALTH RELATED REASONS OR PROBLEMS WHICH WOULD PRECLUDE MY PARTICIPATION IN THE ACTIVITY. I HAVE NOT BEEN ADVISED OF ANY REASON WHICH WOULD LIMIT ME IN PARTICIPATING IN THE ACTIVITY.
I acknowledge that the following Company’s rules shall apply: safety equipment shall be mandatory; I shall participate in the activity while unattended; any participant who is a minor shall need their parent’s signature; I must put on closed toed shoes to participate in the activity; and I shall be denied participation if I have consumed too much alcohol.
I consent to receive any medical treatment deemed advisable for an injury to myself during the activity and that any medical or other insurance for myself will be insurance of first resort before contribution by any other insurance for any other person or entity, including accidental death and dismemberment insurance and accident medical insurance.
I understand that I may be photographed while participating in the activity. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, sponsors, producers, and their assigns.
___________________________________ __________________
Name Date
________________________________________________________________________
Address
________________________________________________________________________
e-mail Address Telephone#
For Minors:
___________________________________ __________________
Parent or Legal Guardian Date
________________________________________________________________________
Address
________________________________________________________________________
e-mail Address Telephone#
_____________________
Minor’s Name/ Age
I shall defend, hold harmless, and indemnify the parties from and against all losses, claims, damages, costs or expenses (including reasonable legal fees, or similar costs) in connection with any action or claim brought or made (or threatened to be brought or made), for, or on account of any injuries or damages, received or sustained by myself and/or my child arising during the course of the activity.
This Agreement constitutes the sole and only agreement between the parties concerning my child’s and my release and indemnification as a condition for participating in this activity. Any prior agreements, whether oral or in writing, shall be void and of no further effect. This Agreement may not be modified.
I certify that I have read this document, and I fully understand its contents. I am aware that this is a release and indemnification of liability for myself and my child, and I sign it of my own free will.
Dated:____________________
__________________________
Participant’s Name (Print)
__________________________
Signature
__________________________
Parent or Guardian of Minor
(Print)
___________________________
Signature
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