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4 Star Obstacles, LLC
13204 Fountainhead Plaza Hagerstown, MD 21742

LIABILITY WAIVER AND RELEASE FORM
Waiver, Acknowledgement of Risks, Injury, and Obligations

I acknowledge that the activity (Parkour, Ninja Warrior, Obstacle Training, and exercise of any kind) I am going to undertake is a dangerous activity and that by participating in it I am exposed to certain risks. I am responsible to consult with my physician before engaging in exercise or any other type of physical activity. I acknowledge and understand that whilst participating in such activity;

  • I may be injured physically, or mentally, or may die;
  • My personal property may be lost or damaged;
  • Other person participating in such activity may cause me injury or may damage my property;
  • I may cause injury to other persons or damage their property;
  • The conditions in which the activity is conducted may vary without warning;
  • There may be no or inadequate facilities for treatment or transport of me if I am injured;
  • I may not use property, equipment, objects, obstacles, or structures, man-made and/or natural, for activities other than their intended uses;
  • 4 Star Obstacles, LLC is not responsible in any way for injury, loss, damage or death caused to myself or my property as a result of any type of equipment failure;
  • I assume the risk and responsibility for any injury, death, or property damage resulting from my participation in the activity; I participate in the activity at my sole risk and responsibility. I release, indemnify and hold harmless 4 Star Obstacles, LLC its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect of or arising out of injury, loss, damage or death caused to me or my property in any way whatsoever. I grant exclusive permission to 4 Star Obstacles, LLC its servants and agents to use my name, likeness, videos, and photographs for the purpose of publicity, public relations, or other advertising purposes without restriction as to frequency or duration

I have read and understand the above terms.

Date of Signing: December 13, 2018

 

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*
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:*
Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Participant Questions

How did you hear about 4 Star Obstacles?

What do you want to get out of your experience at 4 Star Obstacles?
Parent(s) or court appointed legal guardian(s) must sign for any participation 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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