Today's Date: April 26, 2019

I and the minors for whom I sign desire to participate voluntarily in jumpstreets activities and services and to use jumpstreets facilities and premises. In consideration of our use and enjoyment of jumpstreets activities, services,facilities, and premises, I agreeon behalf of myself and also on behalf of my children (or other minors for whom I sign)as follows:

DEFINITIONS. This agreement defines these terms:
(a) Participant. A Participant is the signer as well as any minors on whose behalf he or she signs.
(b) Jumpstreet Releasees. The Jumpstreet Releasees are (i) Jumpstreet, Inc.; (ii) Jumpstreet, LLC; (iii) Jumpstreet13, Inc.;(iv) the owner/landlord of the jumpstreet premises; (v) the designers, owners, manufacturers, sellers, and/or installers ofthe equipment on the jumpstreet premises; and (vi) anyone who is an officer, director, shareholder, employee, agent, orindependent contractor of one (or more) of the entities enumerated in (i) through (v) here.

WARRANTY. I warrant that I have the authority to sign on my behalf as well as on behalf of the minors listed below.

IMAGES. I grant Jumpstreet, Inc.; Jumpstreet, LLC; and Jumpstreet13, Inc.as well as their officers, directors,shareholders, employees, and independent contractorsthe rights to photograph, videotape, and/or record me and theminors for whom I am signing and to use our names, faces, likenesses, voices, and appearances in connection withexhibitions, publicity, advertising, and promotional materials without reservation or limitation.



(a) Assumption of Risk. jumpstreet recommends that all Participants consult aphysician to determine whether jumpstreet activities and services are safe andappropriate. Participant has either consulted a physician or chosen not to do so.Participant understands that the jumpstreet activities, services, facilities, andpremises are potentially hazardous and involve risks of danger or injuryincluding(but not limited to) sprains, strains, fractures, concussions, contusions, lacerations,abnormal blood pressure, heart disorders, fainting, shortness of breath, chest pains,strokes, heart attack, or even DEATH. Participant understands that the description ofthese risks is not complete and that other unknown or unanticipated risks may resultin injury or death. Being duly aware of the risks and hazards associated with thejumpstreet activities, services, facilities, and premises, PARTICIPANT HEREBYVOLUNTARILY ASSUMES FULL RESPONSIBILITY FOR THE RISK of bodily injury, death, orproperty damage that occurs (i) in whole or in part due to the negligence of theJumpstreet Releasees and that occurs (ii) while Participant is in or upon thejumpstreet premiseseven if the bodily injury, death, or property damage is causedin whole or in part by the negligence of the Jumpstreet Releasees.

(b) Disclaimer of Liability. Each Participant agrees that THE JUMPSTREETRELEASEES SHALL NOT BE LIABLE for any claims, demands, injuries, damages, actions,or causes of action whatsoever to a Participant or a Participants property arising outof or connected with the use of the jumpstreet activities, services, facilities, and/or

(c) Covenant not to Sue. Each Participant hereby COVENANTS NOT TO SUE ANYOF THE JUMPSTREET RELEASEES AND RELEASES, WAIVES, AND FOREVER DISCHARGESTHE JUMPSTREET RELEASEES FROM ALL LIABILITY TO PARTICIPANT, his or her spouse,legal representatives, heirs, assigns, children, or anyone claiming by or throughParticipant, for any loss, damage, liability, claim, demand, action, cause of action,cost, or damages resulting therefrom, on account of injury to Participant's person orproperty that occurs while Participant is on jumpstreet premises, while usingjumpstreet facilities, or while participating in the jumpstreet activities or servicesincluding (without limitation) injury resulting in Participant's deathwhether causedby the negligence of the Jumpstreet Releasees, or any of them, or otherwise.

(d) Indemnity. PARTICIPANT AGREES TO INDEMNIFY AND HOLD HARMLESS THEJUMPSTREET RELEASEES, and each of them, against any loss, damage, liability, claim,demand, action, cause of action, cost or damage (including claims brought byParticipants and third parties) resulting therefrom that Participant may incur due tothe presence of Participant in or upon the jumpstreet premiseswhether caused bythe negligence of the Jumpstreet Releasees, or any of them, or otherwise.


GOVERNING LAW AND SEVERABILITY. Participant expressly agrees that this agreement (including its Exculpatory Clause)is intended to be as broad and inclusive as permitted by the laws of the State of Georgia, and that if any portion hereof isheld invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

First Participant's Name

First Name*

Last Name*
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*
* Adult's Email Address

A signed copy of this waiver will be sent to the email address you provide.
Adult's Information

Address *

City *

State *

Zip Code *

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.
* Adult's Name

First Name*

Last Name*
* Adult's Date of Birth*
* Adult'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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