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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

 

MUST BE COMPLETED BY ALL GUESTS AND SIGNED

IF UNDER THE AGE OF 18 MUST BE SIGNED BY THE PARTICIPANT’S PARENT OR LEGAL GUARDIAN

By signing this document, you HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS ESCAPE ROOM GAME, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of Puzzlemental, LLC and the other persons or entities being released below, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. By signing below, you agree to the following terms and conditions:

 

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

  • Possible moving or lifting objects of not more than twenty pounds
  • Mental stress and anxiety
  • Being in a reasonably small space with up to eight persons
  • Possibility of failure to escape the room in the allotted time.
  • May have Strobe lights and Smoke Machines

 

I have no physical or mental illness that prevents my participation in a safe manner for myself or others. I am not under the influence of drugs or alcohol or anything else that may impair my ability to participate in a safe manner for myself or others.

 

I acknowledge that this Accident Waiver and Release of Liability Form will be used by Puzzlemental, and that it will govern my actions and responsibilities at said activity. I agree that all staff may, at their own discretion, determine it is unsafe for myself or others for me to participate, and have the authority to remove me from the premises by any lawful means.

 

By signing this waiver for myself or as the parent or guardian of a minor and in exchange for allowing me (or the minor on whose behalf this waiver is given) to participate in the activities associated with the escape room, I agree to and accept full responsibility in regards to the following:

 

 (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 any participant’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to the participants, THE FOLLOWING ENTITIES OR PERSONS:  Puzzlemental, LLC and its directors, officers, employees, volunteers, representatives, and agents (the “Releasees”);

 

(B) I WILL INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the Releasees with regard to any and all liabilities or claims which may arise as a result of participation in the activity, whether caused by the negligence of a Releasee or otherwise.

 

I acknowledge that the Releasees 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.

 

This Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law and shall be binding on my estate, heirs, executors, administrators, successors, and assigns, as well as any other party asserting a claim on my behalf or on behalf of my estate

 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

 

I am 18 years of age or older and I warrant that I have read and understand that this Agreement involves my waiver and release of significant rights and my assumption of significant indemnification responsibilities in participating in the Event.

First Gamers Name

First Name*

Last Name*

Phone*
First Gamers Date of Birth*
First Gamers Signature*
Second Gamers Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

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

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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