Accident Waiver And Release Of Liability Form printable pdf download

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES

ASSOCIATED WITH THE ROOM EVENT, including by way of example and not limitation, any risks that

may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or

defective equipment or property owned, maintained, or controlled by them, or because of their possible liability

without fault.

I certify that I understand this activity has potential risks including but not limited to:

1) Use of simple tools;

2) Potentially moving or lifting objects of not more than twenty pounds;

3) Mental stress and anxiety;

4) Being in a reasonably small space with up to fifteen persons.

I have no physical or mental illness that precludes my participation in a safe manner for myself or others. I am

not under the influence of drugs or alcohol which impairs my ability to maintain my safety awareness or

endangers others.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the

activity in which I may participate, and that it will govern my actions and responsibilities at said activity. I agree

that all staff or authorized agents may, in their sole discretion, determine it is unsafe for myself or others for my

participation to continue, remove me from the premises by any lawful means.

In consideration of my application and permitting me to participate in this activity, I hereby take action for

myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability

arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury,

property damage, property theft, or actions of any kind which may hereafter occur to me, THE FOLLOWING

ENTITIES OR PERSONS: The directors, officers, employees, volunteers, representatives, and agents of any and

all entities authorizing this activity;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in

this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether

caused by the negligence of release or otherwise.

I acknowledge that the directors, officers, employees, volunteers, representatives, and agents of any authorizing

entity are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a

specific activity on their behalf.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident,

and/ or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film

likeness to be used for any legitimate purpose this authorizing entity decides, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver

to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I

AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY

OWN FREE WILL.

________________________________ _____ __________________________________ ______________

Age  

Participant’s Name

Participant’s Signature

Date

(Please print legibly)

Email address:________________________________________ Phone number:______________________

___ I do NOT want updates about new rooms, games, and special events

IF YOU ARE UNDER 18, A PARENT OR GUARDIAN MUST ALSO SIGN:

________________________________ ___________ Phone Number:_____________________________

Date  

Parent/Guardian Signature

Accident Waiver And Release Of Liability Form

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