Loading...

XTREME NINJA CHALLENGE WAIVER AND RELEASE FROM LIABILITY

Today's Date: December 2, 2021

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS 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 have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. I recognize that this is a voluntary event in which I am choosing to participate and any injury I may sustain while participating in this event is not covered by Xtreme Ninja Challenge, LLC, OLD TOWN KISSIMMEE, LTD., & TRAVCORP USA, INC, their respective affiliates, licensees, lenders and contractors, as well as each of their respective officers, directors, partners, members, shareholders, employees, agents, representatives, successors

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:

WAIVER, RELEASE AND HOLD HARMLESS / INDEMNITY:

(A) I HEREBY WAIVE AND RELEASE XTREME NINJA CHALLENGE, LLC (hereinafter referred to as "XNC"), OLD TOWN KISSIMMEE, LTD., & TRAVCORP USA, INC. their respective affiliates, licensees, lenders and contractors, as well as each of their respective officers, directors, partners, members, shareholders, employees, agents, representatives, successors (“RELEASEES”), FROM ANY AND ALL CLAIMS, LIABILITIES OR CAUSES OF ACTION, WHETHER CAUSED BY RELEASEES’ NEGLIGENCE OR OTHERWISE, INCLUDING WITHOUT LIMITATION DEATH, DISABILITY, BODILY INJURY, PROPERTY DAMAGE, PROPERTY THEFT, OR ANY OTHER LOSS, DAMAGE OR ANY INCONVENIENCE WHATSOEVER, ARISING FROM MY PARTICIPATION IN THIS EVENT (“CLAIMS”).

(B) ADDITIONALY I PROMISE NOT TO SUE, AND AGREE TO DEFEND, INDEMNIFY, AND HOLD HARMLESS the entities or persons mentioned in this WAIVER from any and all liabilities or claims arising, either directly or indirectly, as a result of participation in this activity, whether caused by the negligence of release or otherwise.

 

Assumption of Risk: I acknowledge that this activity may involve a test of a person's physical limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I assume all risks associated with this activity or event.

 

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

 

Media Release: I grant full permission to XNC,OLD TOWN KISSIMMEE, LTD., & TRAVCORP USA, INC. to use photographs, videos and other types of recordings of me in advertising, trade or any commercial purpose in legitimate accounts and promotions of this event and for XNC, OLD TOWN KISSIMMEE, LTD., & TRAVCORP USA, INC. to share my contact information with any related sponsors. I waive the right to inspect versions of my image used for publication or the written copy used in connection with the images.

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*
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
In order for the Participant to participate in the Event, a parent or legal guardian MUST sign below. As a parent or guardian of a Participant at the aforementioned Event, I agree to the terms and conditions contained in this Agreement, and I assume responsibility for the actions of the Participant. I, the undersigned, the parent and natural or legal guardian of minor(s), hereby acknowledge that I have executed the foregoing release for and on behalf of the minor named herein and agree to bind myself, the minor, his/her executors, administrators, heirs, next of kin, successors, and assigns to the terms of the foregoing release. I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility to treat the minor named herein for the purpose of attempting to treat or relieve such injuries. I consent to the administration of all medical care.
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 - TRY IT FREE!