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Pacific Scooter Experience

14766 NE 95th St

Redmond, WA  98052

RELEASE OF LIABILITY, ASSUMPTION OF RISK, WAIVER OF CLAIMS, INDEMNIFICATION
& BINDING ARBITRATION AGREEMENT
Notice – By signing this document you may be waiving certain legal rights, including the right to sue.
Release and Waiver of Claims; Assumption of the Risk; Indemnification Agreement
In consideration of being allowed to use the facilities and participate in Indoor Scooter Park and other activities
(collectively the “Activities”) provided by Pacific Scooter Experience (the “Host”), the Participant, and the Participant’s
parent(s) or legal guardian(s) if the Participant is a minor, do hereby agree, to the fullest extent permitted by law, as
follows:
1) TO WAIVE ALL CLAIMS that they have or may have against the Host arising out of the Participant’s
participation in the Activities or the use of any equipment provided by the Host (“Equipment”), including while receiving
instruction and/or training;
2) TO ASSUME ALL RISKS of participating in the Activities and using the Equipment, even those caused by the
negligent acts or conduct of the Host, its owners, affiliates, operators, employees, agents, officers, and/or any entity to
which the Host owes a contractual indemnification obligation. The Participant and his/her parent(s) or legal guardian(s)
understand that there are inherent risks of participating in the Activities and using the Equipment, which may be both
foreseen and unforeseen and include serious physical injury and death;
3) TO RELEASE the Host, its owners, affiliates, operators, employees, agents, officers, and/or any entity to which
the Host owes a contractual indemnification obligation from all liability for any loss, damage, injury, death, or expense
that the Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Activities and/or use of
the Equipment, including while receiving instruction and/or training. The Participant and his/her parent(s) or legal
guardian(s) specifically understand that they are releasing any and all claims that arise or may arise from any negligent
acts or conduct of the Host, its owners, affiliates, operators, employees, agents, officers, and/or any entity to which the
Host owes a contractual indemnification obligation, to the fullest extent permitted by law. However, nothing in this
Agreement shall be construed as a release for conduct that is found to constitute gross negligence or intentional conduct;
and
4) TO INDEMNIFY the Host, its owners, affiliates, operators, employees, agents, officers, and/or any entity to
which the Host owes a contractual indemnification obligation, from all liability for any loss, damage, injury, death, or
expense that the Participant (or his/her next of kin) may suffer, arising out of participation in the Activities and/or use of
the Equipment, including while receiving instruction and/or training.
Photography/Video Release
Participant hereby grants to the Host, its representatives, and employees the right to take photographs/videos of
Participant in connection with Participant’s participation in the Activities. Participant hereby authorizes the Host to
copyright, use, and publish the same in print and/or electronically. Participant hereby agrees that the Host may use such
photographs of Participant for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web
content.
Personal Responsibility
The Participant and his/her parent(s) or legal guardian(s) certify that Participant has no physical or mental
condition that precludes him/her from participating in the Activities and that he/she is not participating against
medical advice.
The Participant and his/her parent(s) or legal guardian(s) understand that Participant’s participation in the
Activities is voluntary and further understand that they have the opportunity to inspect the Host’s Equipment and
facilities before any participation.
The Participant and his/her parent(s) or legal guardian(s) understand that Participant is obligated to follow the
rules of the Activities and that he/she can minimize his/her risk of injury by doing so and through the exercise of
common sense and by being aware of his/her surroundings.
If, while participating in the Activities, the Participant or his/her parent(s) or legal guardian(s) observe any
unusual hazard or condition, which they believe jeopardizes Participant’s personal safety or that of others,
Participant and/or his/her parent(s) or legal guardian(s) will remove Participant from participation in the
Activities and immediately bring said hazard or condition to the attention of the Host.
FORM 1512 (0417) Page 1 of 2 General - Waiver A
Binding Arbitration
The Participant, and the Participant’s parent(s) or legal guardian(s) if the Participant is a minor, hereby agrees to
submit any dispute, claim, or controversy, relating to and/or arising from (a) this Release of Liability, Assumption of
Risk, Waiver of Claims, Indemnification & Binding Arbitration Agreement, (b) Participant's participation in the
Activities, and/or (3) any other interaction between the Participant and the Host, including the determination of the
scope or applicability of this agreement to arbitrate, to binding arbitration. For such disputes, there shall be a
three-member arbitration panel, consisting of two party-appointed arbitrators (one arbitrator to be appointed by
each party) and one neutral arbitrator (collectively, the “Panel”), to be chosen by the party-appointed arbitrators.
In the event that the two party-appointed arbitrators are not able to agree on a third, neutral arbitrator, the neutral
arbitrator shall be appointed by the United States District Court, for the district in which the Activities occurred.
Each party shall pay its own costs, including the costs associated with the party-appointed arbitrators, and the
parties shall share equally the costs associated with the neutral arbitrator. The arbitration proceeding shall proceed
in the State and County where the Activities occurred, and shall be governed by the Federal Rules of Evidence. The
Panel shall establish a reasonable and appropriate discovery schedule to expeditiously resolve this matter. As a
threshold matter, the Panel shall confirm whether the Waiver and Release contained in this Agreement are
enforceable under applicable law. Judgment on the Award may be entered in any court having jurisdiction over the
parties and controversy. Participant and the Host specifically intend this Binding Arbitration provision to survive in
the event that any other portion of this Agreement is held invalid. NOTICE TO PARTICIPANT: By signing this
Agreement, you are giving up your right to commence litigation against the Host in a court of law, and you are
giving up your right to a trial by jury.
To the extent that any portion of this Agreement is deemed to be invalid under the law of the applicable jurisdiction, the
remaining portions of the Agreement shall remain binding and available for use by the Host and its counsel in any
proceeding.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS
AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

FORM 1512 (0417) Page 2 of 2 General - Waiver A

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's 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*

Middle 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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