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D&L Ultimate Movement LLC, DBA - Ultimate Obstacles - Acknowledgement and Assumption of Risk

I, being 18 years or older or guardian for minor, request to participate in practice, competitions, fitness classes or birthday parties at Ultimate Obstacles and to receive instruction in such subjects from the Ultimate Obstacles staff and associates. I understand that such participation and instruction require the performance of physical exercises by me or my child which necessarily involve inherent risks including, without limitation, risks related to the use of equipment and facilities, personal safety (including risk of minor, serious or mortal personal injury) and risks of property damage. Neither my child nor myself are under compulsion by Ultimate Obstacles, its officers, teachers, employees, agents, volunteers and associates (collectively, the “Releases”) to participate in this program nor am I being paid to do so. My child’s and my interest is solely in the activities at Ultimate Obstacles and his/her/my self-improvement and I/we willingly accept the risk inherent in this pursuit.  Other than as set forth above, I hereby certify that I/my child is/are in good health with no condition, illness or abnormality that might subject me/the child to undue personal risk from engaging the in the activities described above.  In the event of any emergency requiring medical care, Ultimate Obstacles is hereby authorized to use its best efforts to obtain whatever medical treatment it deems necessary or appropriate under the circumstances.  In consideration of the opportunity for me and/or my child to use these facilities, I hereby for myself and/or my child forever release the Releasees from all liability for any and all damages and injuries suffered by me or my child in connection with said use of these facilities, whether or not caused by the sole or partial negligence (including future negligence) of any Releasee(s) and further agree to indemnify and hold harmless the Releasees from any loss, liability, damage or costs (including court costs and attorneys’ fees) that may be incurred by my/my child’s participation in the aforementioned activities.  By signing below I hereby acknowledge and agree that I have read this Acknowledgment and Assumption of Risk and that I am waiving substantial rights including my/my child’s right to sue, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.  If any portion of this Acknowledgment and Assumption of Risk is held invalid, the undersigned agrees that the balance shall nevertheless continue in full force and effect.

I have read the above and agree.       

I Agree

I am aware that NO ONE over the age of 35 is allowed on the 12 or 14 ft. Warped Walls without express permission.

I have read the above and agree. 

I Agree

Photo Release

I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for my or my child's participation, I herby grant permission for my or my child's likeness to be used in Ultimate Obstacles publicity or advertising.

I have read the above and agree. 

I Agree

I have read and understood the above ACKNOWLEDGMENT and ASSUMPTION OF RISK and PHOTO RELEASE.

Annual Insurance Fee is good for one year from date of enrollment and is never refundable.

I have read the above and agree. 

I Agree

Date Signed: September 19, 2018

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*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*
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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