Loading...

Waiver of Liability, Assumption of Risk, Indemnity and Name and Likeness Release

In consideration for being permitted to participate in any way in any and all activities and/or play structures, equipment and property in, on or around the premises of Ginger Bugs, LLC dba GINGERBUGS located at 312 N. Ham Lane, Lodi, CA 95242, Suite #3 (the “Activity”), I, for myself, my heirs, personal representatives, assigns and minors under my custody or supervision, do hereby covenant not to sue and release, waive, discharge Ginger Bugs, LLC and its officers, directors, owners, members, employees, representatives, agents, insurers and affiliates (the “Releasees”) from any and all claims including, without limitation, the negligence of the Releasees resulting in personal injury, accidents, illnesses (including death) and property loss arising from, but not limited to, participation in the Activity. I also acknowledge, understand and agree that participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid accident or injury.  I also acknowledge, understand and agree that the specific risks range from minor injuries such as scratches bruises and sprains to major injuries such as loss of sight, joint or back injuries, heart attacks, concussions, paralysis and even death.  Despite these inherent risks, I hereby assert that my participation in the Activity is voluntary and I knowingly assume all such risks.     

I also agree to indemnify, defend and hold Releasees harmless from and against any and all claims, actions, suits, procedures, costs, expenses, fees, damages and liabilities, including attorneys’ fees brought as a result of my involvement in the Activity and to reimburse Releases for such expenses if incurred.  I likewise acknowledge that Releases make take photographs, video or other recordings of my name, likeness, voice and/or image while participating in the Activity and hereby consent to use of my name likeness, voice and/or image for commercial purposes including, without limitation, marketing collateral, websites, videos, presentations and related purposes.   

I expressly agree that the foregoing waiver, release, assumption of liability and name and likeness release are intended to be as broad and inclusive as permitted under applicable law and that if any portion hereof is invalid, it is agreed the balance shall, notwithstanding, continue in full force and effect.  Likewise, I have read this document in its entirety, fully understand its terms and understand I am giving up substantial rights, including my right to sue.  I acknowledge I am signing this document freely and voluntarily and that it applies to me, my heirs, assigns, personal representatives and any and all minors under my custody and/or supervision.  

I have had sufficient opportunity to read through this doccument and understand I am soley responsible for the minor(s) in my custody and will abide by all facility rules

I Agree
 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*
Parent or Guardian's Phone Number

Phone Number
How did you hear about us?
Click to customize multiple choice*
Friends
Macaroni Kid
San Joaquin Parents Magazine
Online
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*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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