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Waiver Required for Sky Walker and Laser Tag Attractions

PHYSICAL ACTIVITY RELEASE

I hereby fully waive and release HeadPinz/Bowland/BMA and its employees, officers, directors, shareholders, affiliates, agents, representatives, successors and assigns (collectively Releasees), from any and all claims, demands, damages, costs, expenses, causes of action (Claim) in respect of death, personal injury, property damage, or death arising from my participation in the following physical activities: Laser Tag, Ropes Course, Juke N Box, and/or Bowling, (activities) notwithstanding any Claim may have been contributed to or occasioned by the negligence of any of the Releasees.

I hereby indemnify and hold harmless the Releasees from and against any and all liability incurred by any or all of them arising as a result of or in any way connected to my participation in the any activities at this venue.

I hereby voluntarily, at my own risk, sign this Release in sole consideration of being permitted to use the Companys facilities or property.

I have read and understood the foregoing, and acknowledge my consent to the terms of this form by signing this Release.

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*

Confirm Email*
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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.
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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