Today's Date: July 20, 2019

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS INSOMNIA ESCAPE ROOM EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I understand this activity has potential risks including but not limited to:

1) Use of simple tools;
2) Potentially moving or lifting objects of not more than ten pounds;
3) Mental stress and anxiety;
4) Being in a reasonably small space with up to 8 people;
5) The possibility of failure to escape the room in the allotted time.

I have no physical or mental illness that precludes my participation in a safe manner for myself or others. I am not under the influence of drugs or alcohol which impairs my ability to maintain my safety awareness or endangers others. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the activity in which I may participate and that it will govern my actions and responsibilities at said activity. I agree that all staff or authorized agents may, in their sole discretion, determine it is unsafe for myself or others for my participation to continue, remove me from the premises by any lawful means. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, THE FOLLOWING ENTITIES OR PERSONS: The directors, owners, officers, employees, volunteers, representatives, and agents of any and all entities authorizing this activity;
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that the directors, owners, officers, employees, volunteers, representatives, and agents of any authorizing entity are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose this authorizing entity decides and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.


I agree not to make video or photos unless the Game Master permits it. I agree not to publish details of the activity on media, social media, Internet, etc. to keep the fun for everyone (No spoilers policy).

I agree to pay for the items I brake within the room.

First Players Name

First Name*

Last Name*
First Players Date of Birth*
First Players Signature*
Second Players Name

First Name*

Last Name*
Second Players Date of Birth*
Third Players Name

First Name*

Last Name*
Third Players Date of Birth*
Fourth Players Name

First Name*

Last Name*
Fourth Players Date of Birth*
Fifth Players Name

First Name*

Last Name*
Fifth Players Date of Birth*
Sixth Players Name

First Name*

Last Name*
Sixth Players Date of Birth*
Seventh Players Name

First Name*

Last Name*
Seventh Players Date of Birth*
Eighth Players Name

First Name*

Last Name*
Eighth Players Date of Birth*
Ninth Players Name

First Name*

Last Name*
Ninth Players Date of Birth*
Tenth Players Name

First Name*

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

Check to receive information on our new rooms and special offers
A signed copy of this waiver will be sent to the email address you provide.
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*
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.

One or more problems exist. Please scroll up.

Powered by  Smartwaiver