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Today's Date: December 18, 2018

THIS IS A RELEASE OF LIABILITY.
READ BEFORE SIGNING.

This agreement releases PUZZLES LLC from all liability relating to injuries that may occur on site and/or during one of events.

By signing this agreement, I agree to hold PUZZLES LLC entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in this activity. These may include but are not limited to injury, psychological, emotional, spiritual, and physical distress, and/or death.

I confirm that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.

I also agree to reimburse PUZZLES LLC for damages I inflict on the property or any material goods owned by PUZZLES LLC, intentionally or unintentionally, during the course of the event, at a cost deemed appropriate by PUZZLES LLC owners or staff. I acknowledge that PUZZLES LLC will bill the credit card on file for these damages.

I also acknowledge that PUZZLES LLC premises are under video surveillance and I give my consent to be recorded.

I also acknowledge that PUZZLES LLC staff reserves the right to refuse anyone for any reason, and at any time during the course of the event, without refunding any portion of the cost of your tickets.

By signing below I forfeit all right to bring a suit against PUZZLES LLC for any reason. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally.

I will ask for clarification when needed.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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
Check to receive information, news, and discounts by e-mail.
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*
I certify that I am 18 years of age or older
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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