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FLUSHING FARMS LLC

WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

I agree to the following Waiver of Liability, Assumption of Risk and Indemnity Agreement (“Agreement”) with Flushing Farms, LLC, a Michigan limited liability company (“Flushing Farms”) as a condition for allowing me and any minor participants under my supervision entry to participate in any or all of the activities provided at Flushing Farms, including but not limited to pumpkin patch, hayride/wagon ride, corn maze, petting zoo, animal contact, picnic area and other outdoor recreational activities, which are individually or collectively referred to as the “Activities.”

I enter into this agreement, individually, and on behalf of my children/Minor Guests and agree all parts of this Agreement shall apply to them. As used in this Agreement “I” and “my” shall collectively refer to myself, my minor children and any other minors under my supervision. I acknowledge and agree that I am the Responsible Party for any minor guests I bring to Flushing Farms.

I expressly agree as follows:

1. I have requested to participate in any or all of the Activities.

2. I certify that I, and each minor for which I am the Responsible Party, do not have any physical condition that would interfere with or limit my ability to participate in the Activities.

3. Risks. I understand there are or may be risks associated in the Activities, whether inherent, or due to negligence or carelessness of the persons or entities being released, including the terrain, temperature, weather conditions, participation by other people, temperament of animals, and defective equipment or property. Further, I understand that animals, including customary farm animals, may be temperamental and unpredictable. They may bite/nibble if eating or being petted or otherwise touched, that animals may unpredictably push into people causing them to fall or impact other people or structures. I understand participation in the Activities may involve serious bodily injury, including disfigurement and death which may be caused by my own actions, other participants, the conditions, terrain, negligence of the Releasees named above and other risks or conditions not readily foreseeable. Knowing this, I fully assume all risks, costs, damages that I may incur by participating in the Activities.

4. Waiver/Release/Indemnification. I, individually and on behalf of my heirs, executors, successors, and assigns, hereby voluntarily and fully release, waive, discharge, hold harmless, defend and indemnify Flushing Farms, LLC, its owners, members, officers, employees, agents, including independent contractors, from, against and for any and all liability, claims, causes of action, damages, costs, fees, and injuries, including, but not limited to, death arising from or in connection with my participation in the Activities, known or unknown, foreseeable or unforeseeable, for whatever reason including negligence.

5. Michigan Law. This Agreement is governed by Michigan law and is intended to be as broad and inclusive as possible. This document may only be modified, in writing, signed by an officer of Flushing Farms, LLC. Should any part of this Agreement conflict with Michigan law, only that part in conflict shall be void and the remainder shall remain in full force and effect. 

I have read this Agreement and understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or promises and further understand that it is intended to be construed as broadly as possible as a complete and unconditional release of all liability on the part of Flushing Farms, LLC.

By signing this agreement, I acknowledge it applies to me, my children listed above and any listed minor guests.

October 6, 2022

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's 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:*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

PARENTAL CONSENT I, the minor’s parent/legal guardian, understand the nature of The Activities and know the minor’s experience and capabilities and believe the minor to be qualified to participate. I hereby acknowledge that this assumption of risk, waiver of release and indemnification also extends to the minor child(ren).



By signing below the Parent or Court-Appointed Legal 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*
I certify that I am 18 years of age or older
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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