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GELLYBALL BY

HotShotz N' Heroes, LLC

Participation Waiver

HotShotz N’ Heroes LLC = HSN’H

Phone: (716) 474-6670

www.hotshotznheroes.com

RELEASE OF LIABILITY, INDEMNITY AND ASSUMPTION OF RISK

READ BEFORE SIGNING


**Must Be At Least 5 Years of age to Participate. Those Between 5-18 Years of Age Must Have Waiver Signed by Parent or Guardian who is 18 years of age or older **

July 8, 2024


IN CONSIDERATION of being permitted to participate in any Gellyball activities including, but

not limited to, playing, using the premises of, renting and operating equipment leased, sanctioned

and/or operated by the above named vendor,

I acknowledge and agree that:

I fully understand and acknowledge that;

(a) risks and dangers exist in my use of Gellyball

equipment and my participation in Gellyball activities;


(b) my participation in such activities and/or

use of such equipment may result in my injury or illness including but not limited to bodily injury,

disease strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack,

death or other ailments that could cause serious disability;


(c) these risks and dangers may be

caused by the negligence of the owners, employees, officers or agents of HSN’H; the negligence of

the participants, the negligence of others, accidents, breaches of contract, the forces of nature or

other causes. These risks and dangers may arise from foreseeable or unforeseeable causes; and


(d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers

and all responsibility for any losses and/or damages, whether caused in whole or in part by the

negligence or other conduct of the owners, agents, officers, employees of HSN’H, or by any other

person.


I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to

release, waive, discharge, hold harmless, defend and indemnify HSN’H and it’s owners, agents,

officers and employees from any and all claims, actions or losses for bodily injury, property damage

(including, but not limited to, arising out of the actual or alleged transmission of a communicable

disease), wrongful death, loss of services or otherwise which may arise out of my use of Gellyball

equipment or my participation in Gellyball activities. I specifically understand that I am releasing,

discharging and waiving any claims or actions that I may have presently or in the future for the

negligent acts or other conduct by the owners, agents, officers or employees of HSN’H. This waiver is

good through 9/1/2024.


MEDICAL PERMISSION AUTHORIZATION

If the participant is of minority age, the undersigned parent or guardian hereby gives

permission for HSN’H to authorize emergency medical treatment as may be deemed necessary for

the child named below while participating in Gellyball games.


I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO

EXEMPT AND RELIEVE HSN’H FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR

WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:

Parent(s) or 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 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*

Phone*
Parent or Guardian's Date of Birth*
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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