Activity: obstacle course that includes zip lines traveling at height, through and above trees
Date of Activity: December 13, 2018
The TTQ Philly adventure course is a high risk and potentially dangerous activity that can result in serious injury or death. Participation in all aspects of the activity is voluntary. The ultimate responsibility for participant safety lies with the participant. Not wearing a helmet may have certain risks which you are aware of and acknowledging. All children 6 y/o and under must wear a helmet at all times.
I, the undersigned, am the parent and/or legal guardian of the minor(s) listed below who is/are under 18 years old, or the applicable age of majority, and is at least 4 years old. I wish that such minor(s) participate in the Activity offered by TTQ Philly on the date of this release.
One adult may supervise one minor who is under 7 years old. One adult may supervise up to 3 minors who are between 7 and 17 years old.
Activity Participation Acknowledgment.
On behalf of the minor(s) listed above, I desire to participate in the activity described above (the “Activity”), including, without limitation, to participate in an activity for which TTQ Philly is furnishing equipment and services and which requires physical exercise, including without limitation, helmet (for 6 y/o and under), harness, belay system, and to otherwise enter an area where the Activity takes place, or to observe or otherwise participate in or in any other way be involved for any purpose with the Activity. In consideration of being permitted to participate in the Activity, I hereby agree to all the terms of this Release of Liability and Waiver of Rights (this “Release and Waiver”) on behalf of the minor(s), including all the covenants and agreements listed on the reverse side of this form.
This Release and Waiver shall be binding upon and enforceable against the minor(s), myself, my personal representatives and the minor(s)’s personal representatives, their assigns, heirs, and next of kin without limitation. It is my desire and intent that the words, terms, provisions, covenants, and remedies contained in this Release and Waiver shall be enforceable to the fullest extent permitted by Applicable Law. If any portion of this Release and Waiver is held invalid, the remainder shall not be affected and shall continue in full legal force and effect. That shall include modifying the Release and Waiver to allow any remaining claims to be waived, released, and indemnified against in the event that the inclusion of any particular provision is found to be invalid or contrary to public policy. The terms of this Release and Waiver shall continue from this date forever. This document constitutes the entire agreement between TTQ Philly, the minor and myself and supersedes any previous or contemporaneous discussions or agreements between us in respect of these matters.
On behalf of the minor(s), I specifically acknowledge and agree that this document is not intended to be a general release subject to limitations and conditions that would otherwise apply under applicable state laws, ordinances, statutes, rules, and regulations (collectively, “Applicable Law”), and additionally agree to WAIVE ANY AND ALL GENERAL RELEASE LIMITATIONS PROVIDED BY APPLICABLE LAW OR ANY RIGHTS GRANTED TO ME UNDER APPLICABLE LAW. This Release and Waiver shall be construed and interpreted as broadly as possible under the Applicable Law of the jurisdiction in which the Activity takes place.
ON BEHALF OF THE MINOR(S), I HAVE READ THIS RELEASE AND WAIVER (INCLUDING THE COVENANTS AND AGREEMENTS ON THE REVERSE SIDE), FULLY UNDERSTAND ALL THE TERMS, UNDERSTAND THAT I MYSELF AND THE MINOR(S) ARE VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING BELOW, AND I HAVE SIGNED THIS RELEASE (INCLUDING THE COVENANTS AND AGREEMENTS ON THE REVERSE SIDE) FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT, ASSURANCE, OR GUARANTEE OF ANY NATURE BEING MADE TO ME.
I HEREBY WARRANT THE TRUTH OF THE ABOVE STATEMENTS AND I DECLARE THAT I HAVE NOT WITHHELD ANY INFORMATION THAT WOULD INFLUENCE THE DECISION OF TTQ PHILLY IN ALLOWING ME OR THE MINOR(S) TO PARTICIPATE IN THE ACTIVITY, INCLUDING, WITHOUT LIMITATION, ANY MENTAL, PHYSICAL OR MEDICAL CONDITIONS WHICH MAY AFFECT MY ABILITY OR THE MINOR(S)’S ABILITY TO PARTICIPATE IN THE ACTIVITY.
On behalf of the minor(s), I hereby irrevocably and unconditionally agree for the minor(s), myself, the minor’s personal representatives, their heirs, next-of-kin, insurers, successors, and assigns, as follows:
1. ASSUMPTION OF RISK. My choice to participate in the Activity with the minor(s) (named on the front side of this document) is knowing, voluntary, and made for our personal enjoyment. I understand that participation in the Activity involves inherent risks and dangers of accidents, rescue operations, emergency treatment, property loss or damage, serious personal and bodily injury, death, and severe personal and economic losses. More specifically, on behalf of the above listed minor(s), I acknowledge that by participating in this dangerous and high risk Activity, the minor(s) may suffer bodily injury or death or loss or damage to property. These may result not only from my own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, or the condition of the facilities, equipment, or vehicles. Further, there may be other risks not known to me or reasonably foreseeable at this time. On behalf of the minor(s), I understand and I have considered the risks involved, and I voluntarily and freely choose to assume these risks.
2. RELEASE FROM LIABILITY. On behalf of the minor(s), I fully and forever release and discharge TTQ Philly and its respective affiliates, directors, officers, shareholders, employees, agents, and insurers, and all others involved in the Activity (collectively referred to in this Release and Waiver as “TTQ Philly”) from any and all injuries (including death), losses, damages, claims (including negligence claims), demands, lawsuits, expenses, and any other liability of any kind, of or to me, my property, or any other person, directly or indirectly arising out of or in connection with my participation in the Activity, even if it is due to the negligence, injudicious act, omission, or other fault of TTQ Philly.
3. INDEMNITY. On behalf of the minor(s), I will defend, indemnify, hold harmless and reimburse TTQ Philly from and for all damages, losses, costs, or expenses (including legal fees) incurred by TTQ Philly or paid by them to any person (including me or my insurers) in respect of any accident, injury (including death), loss, or property damage, however caused resulting from, arising out of, or otherwise in connection with my participation in the Activity. I will reimburse TTQ Philly if anyone makes a claim against TTQ Philly in connection with my participation in the Activity, including, without limitation, any accident I may be involved in or any injury, loss, damage to me, other parties or property however caused.
4. COVENANT NOT TO SUE. On behalf of the minor(s), I will not initiate any claim, lawsuit, court action, or other legal proceeding or demand against TTQ Philly, nor join or assist in the prosecution of any claim for money or other damages which anyone may have, on account of injuries (including death), losses, or damages sustained by me, other parties, or my (or others’) property in connection with my participation in the Activity, and I waive any right I may have to do so. This means that I cannot sue to hold TTQ Philly responsible for any injury, loss, or damage sustained by me, other parties, or my (or others’) property in connection with the Activity, even if it is due to the negligence, injudicious act, omission, or other fault of TTQ Philly. I waive my insurers’ right to make a claim against TTQ Philly based on payments by insurers to me or on my behalf for any reason. This means my insurers have no rights of subrogation against TTQ Philly.
5. MEDICAL EXPENSES. On behalf of the minor(s), I hereby consent to receive medical treatment which may be deemed necessary in the event of any illness, accident or injury, or medical emergency resulting from or in connection with my participation in the Activity and understand that I am solely responsible for all costs related to such medical treatment, medical transportation and/or evacuation.
6. REPRESENTATIONS. The minor(s) is/are in good health, in proper physical condition, and do not have any medical or other conditions that would impair their ability to participate in the Activity. If at any time I believe conditions to be unsafe for the minor(s) or that the minor(s) is/are no longer in proper physical condition to participate in the Activity, I will immediately discontinue further participation in the Activity. I agree that I will be at the same site or location as such minor(s) at all times and that I will be able to see them at all times. I agree and acknowledge that I am solely responsible for the safety of the minor(s) and the security of any of the minors’ possessions at all times. I agree to determine if any part or all of the Activity is appropriate or feasible by the minor(s) based on the physical and mental ability of the minor(s), and will remove the minor(s) from the Activity should performance by that minor appear unsafe
7. COVENANTS. I will follow any and all instructions, recommendations, and cautions of TTQ Philly at all times during the Activity, including, without limitation, in respect of my operation of any obstacles or zip lines at the Activity or other participation in the Activity. I will comply with all Applicable Laws while participating in the Activity. I will operate and behave in a safe manner and will observe all instructions, recommendations or orders from TTQ Philly and any its personnel. I will not participate in the Activity while under the influence of any alcohol or illegal drug, or any intoxicant, narcotic, prescription medicine, or other drug which would impair my ability to operate or ride in a vehicle.
ON BEHALF OF THE ABOVE LISTED MINOR(S), BY SIGNING I ACKOWLEDGE THAT I HAVE READ THIS ASSUMPTION OF RISK AND RELEASE AND WAIVER OF LIABILITY AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIONAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A RELEASE OF LIABILITY AS PROVIDED FOR HEREIN.