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HOUSE OF 42 WAIVER
AND RELEASE OF LIABILITY

By signing my name below, I acknowledge that I have carefully read this document and fully understand and agree to its terms and conditions and that I hereby release House of 42 of any and all liability resulting from my participation in its activities (“Activity”). 

I voluntarily consent to participate in this Activity and enter this agreement without duress or coercion. I have the right to refuse to sign this form. The House of 42 reserves the right to deny participation if this form is not signed.

I acknowledge that my participation in the Activity may include the consensual engagement with Sacraments cultivated by the House of 42. I acknowledge my participation is part of my freedom of religion, and under the protections of the First Amendment of the United States laws and Constitution.  

I understand and accept the risks and potential benefits of my participation in the Activity. I acknowledge that no guarantee, claim or promise regarding the curing of any illness, or the nature of any experience has been given. I freely choose to enter this process accepting full responsibility for whatever may occur, anticipated or unanticipated during the event or due to my participation in it.

I hereby indemnify House of 42, its partners, and the event venue of any and all liability for any loss, damage, expense, injury, or death, both to person and to property that I may suffer or that any third party may suffer as a result of my participation due to any cause, including from the risks, dangers, and hazards from third party participants. 

I understand that the Activity may be physically, mentally, or emotionally demanding or upsetting, and I accept full responsibility for any physical, mental, emotional and other challenges resulting from it, both during and following the Activity. 

I attest that I am in good physical, mental and emotional condition to engage in this Activity and I am not aware of any infirmity that would place me at risk to participate in any way in the Activity. I have been truthful in disclosing my fitness to participate, prescribed medications, and medical history. I understand that failing to disclose this information accurately could result in serious injury or death.

I commit to following the protocols and instructions during the event. These include and are not limited to staying at the event space until having been cleared by event organizers to leave and staying within the designated requested areas on premises at any time during the event. I agree not to go in or near the pool until permitted by the organizers to do so. 

I understand that House of 42 does not provide medical or personal property insurance. I further acknowledge that injuries sustained may be compounded by House of 42's actions, omissions, or negligence, including emergency response or rescue operations. Nonetheless, I am participating voluntarily and entirely at my own risk. It is my responsibility to secure any insurance I deem necessary. 

I authorize House of 42 to provide emergency medical care if deemed necessary, including first aid, CPR, emergency transport, or treatment by qualified staff, third party, or medical personnel. I agree to be financially responsible for any costs arising from any medical treatment or personal property damage arising from my participation in the Activity.

I understand, acknowledge, and agree to the importance of the privacy of the event, its participants, and information shared during the event, and agree not to share any of this information with anyone. I agree not to record, publish, or disclose any details of the Activity, participants, or facilitators without express permission from each individual involved.

I agree to cover contributions as requested by event organizers and agreed upon. I acknowledge that the House of 42 offers financial consideration to those in need. Any monetary contribution I make is of my own free will. 

I understand and agree that this Waiver and Release of Liability Agreement shall be binding upon my heirs, next of kin, executors, administrators, assignees, representatives, trustees, and guardians in the event of my death or incapacity. 

This agreement is clear and unambiguous as to its terms, intended to be understood in its plain language. This agreement contains the entire understanding between myself and House of 42, and supersedes any previous agreements or promises.

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Second Participant's Signature*
Third Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Third Participant's Signature*
Fourth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Last Name*
Phone*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email*
Keep me in the loop. I understand House of 42 does not spam.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal 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 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*
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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