Loading...

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH DIGITAL REALITY GAMING (DRG), including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I agree that this agreement is made on behalf of myself and any minors listed below and that all of the releases, waivers and promises herein are binding on that minor. I represent that I have full authority as a parent or legal guardian to bind any minor named below to this Agreement. I understand that participating in virtual reality activities may result in nausea, dizziness and other potential discomfort and persons may not participate if they have epilepsy or heart, circulation or nervous system conditions. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. I certify that there are no health-related reasons or problems which preclude my participation in this activity. Participant consents to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. Participant hereby affirms that they have adequate insurance to provide coverage for such medical expenses. Participant understands and agrees that DRG will not pay for any medical expenses incurred because of injury. I acknowledge that this Accident Waiver and Release of Liability will be used by DRG for the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (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 my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that DRG and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. DRG offers a variety of software titles with a range of genres and ratings. DRG staff can provide helpful recommendations regarding content, but it is the sole responsibility of the parent /guardian of any patron under the age of eighteen (18) to ensure that the content selected by them is deemed appropriate. Participant understands while participating in this activity, they may be photographed. Participant agrees to allow a photo, video, or film likeness to be used for any legitimate purpose by DRG. I agree to hold harmless and indemnify DRG from any and all liability for any property damage or personal injury to any third party resulting from my use of DRG virtual reality equipment. I also agree to indemnify and fully compensate DRG for any property damage I cause, including but not limited to DRG virtual reality equipment. I am responsible and liable for all equipment I use. If I, or my child, break or damage a controller, headset or computer I agree to reimburse DRG before leaving the premises. I acknowledge that I have read, viewed or heard the DRG store rules governing my participation and/or my child’s participation in any activity at DRG. I certify that I understand and have explained the DRG Store Rules to my child. I agree that if the Participant is a minor, I will defend, indemnify and hold harmless DRG from any and all claims or suits for personal injury, property damage or otherwise which are brought by, or on behalf of the minor, and which are in any way connected with such use or participation by the minor, including injuries or damages caused by the negligence of DRG. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 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. IF UNDER AGE EIGHTEEN (18) COMPLETE SECTION BELOW WITH PARENT OR LEGAL GUARDIAN SIGNATURE. I AGREE THAT DRG, IT'S STAFF CAN COMMUNICATE WITH ME DIGITALLY INCLUDING VIA EMAIL AND SMS COMMUNICATION. INFORMATION PROVIDED TO DRG WILL NOT BE SOLD OR TRANSFERRED AND I UNDERSTAND THAT I CAN UNSUBSCRIBE FROM COMMUNICATIONS AT ANY TIME.

 

I Agree

First VR Gamers Name

First Name*

Last Name*

Phone*
First VR Gamers Date of Birth*
I certify that I am 18 years of age or older
First VR Gamers Signature*
Second VR Gamers Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth VR Gamers Date of Birth*
VR Gamers Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*
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 - TRY IT FREE!