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LUMBER JACK'S LODGE

RELEASE OF LIABILITY WAIVER

I, the undersigned (hereinafter, the “RELEASOR”), desiring to participate in the services and activities (including, but not limited to axe throwing and any other recreational or amusement activity, collectively referred to herein as “ACTIVITIES”) on the date as set forth below, having been organized and provided by Lumber Jack’s Lodge, Inc. (hereinafter, “LUMBER JACK’S LODGE”), hereby agrees to and releases the following:

In consideration for being allowed to participate in the ACTIVITIES on the date as set out below, which consideration is hereby expressly accepted and acknowledged, on behalf of myself, my representatives, heirs, agents, administrators, trustees, executors, assigns, successors and on behalf of any party or parties who claim a right or interest through me, I HEREBY RELEASE, ACQUIT, AND FOREVER DISCHARGE, WITHOUT QUALIFICATION OR LIMITATION any and all claims I may now and/or in the future have against LUMBER JACK’S LODGE, and from any and all liability, for any personal injury, disability, paralysis, death and/or property damage, expense, and/or loss sustained by me as a result of my participation in the ACTIVITIES due to any cause whatsoever, including but not limited to and without limitation, negligence, gross negligence, willful misconduct, including the failure to take reasonable steps to safeguard or protect me from the risk, dangers, and/or hazards of participating in the ACTIVITIES.

THE RELEASOR AGREES AND ACKNOWLEDGES that this release of liability shall extend to all owners, members, principals, employees, agents, volunteers, independent contractors, insurers, facility operators, premise owners, and all other persons or entities acting in any capacity on the behalf of LUMBER JACK’S LODGE.

THE RELEASOR ACKNOWLEDGES AND ACCEPTS that the ACTIVITIES may be inherently risky and dangerous, and there is the possibility of personal injury, disability, paralysis, death, property damage and/or loss resulting therefrom.

THE RELEASOR AGREES AND UNDERSTANDS that in order to participate in the ACTIVITIES on the date set out below, he/she must agree to be bound by the terms of this Release of Liability Waiver and accepts all risks related to the ACTIVITIES.

THE RELEASOR AGREES that he/she will be fully responsible for all costs and expenses that may be incurred in providing any special services to him/her, outside of regular services agreed to or provided by LUMBER JACK’S LODGE in connection with the ACTIVITIES, and without limiting the generality of the foregoing, agrees to be responsible for, and to pay for any and all costs relating to special travel, medical attention, or other special outlay for him/her personally, and to reimburse LUMBER JACK’s LODGE for all costs of these services as may be incurred by them for his/her benefit or at his/her request.

THE RELEASOR HEREBY CONFIRMS that by executing this agreement, he/she is representing that he/she is at least eighteen (18) years of age and that he/she has read, and understands, this agreement. The RELEASOR acknowledges that he/she is in good general health, in proper physical condition to participate, and is not under the influence of any substances, including alcohol or prescription or illegal drugs, which may affect or impair his/her motor skills, judgment, or general ability to think clearly.

IT IS AGREED AND UNDERSTOOD that if the RELEASOR commences any legal action, or takes such legal proceedings, and LUMER JACK’s LODGE is added to such proceeding in any manner whatsoever, whether justified in law or not, the RELEASOR will immediately discontinue the proceedings and/or claims, and the RELEASOR will be jointly and severally liable to LUMBER JACK’s LODGE for the legal costs incurred in any such proceeding, on a substantial indemnity basis. This Release of Liability Waiver shall operate conclusively as an estoppel in the event of any claim, action, complaint or proceeding which might be brought in the future by the RELEASOR with respect to the matters covered by this Release of Liability Waiver. This Release of Liability Waiver may be pleaded in the event any such claim, action, complaint or proceeding is brought, as a complete defense and reply, and may be relied upon in any proceeding to dismiss the claim, action, complaint or proceeding on a summary basis and no objection will be raised by the RELEASOR in any subsequent action that the other parties in the subsequent action were not privy to formation of this Release of Liability Waiver.

THE RELEASOR ACKNOWLEDGES that this Release of Liability Waiver contains the entire agreement between the parties hereto, that the terms of this Release of Liability Waiver are contractual, are not a mere recital, and any breach of these terms may be enforced against the RELEASOR and may give rise to a damage claim against the RELEASOR enforceable by a further legal proceeding. The RELEASOR further acknowledges that LUMBER JACK’S LODGE has not made any oral, written or visual representations or statements that are not otherwise reflected in this agreement.

THE RELEASOR HEREBY AGREES that this Release of Liability Waiver will be governed by the Laws of the Commonwealth of Kentucky and that any dispute arising from this Release of Liability Waiver will be adjudicated by the Commonwealth of Kentucky, and the RELEASOR hereby agrees to the exclusive jurisdiction of this court for this purpose.

THE RELEASOR HEREBY GRANTS LUMBER JACK’S LODGE non-revocable permission to capture his/her image and likeness in photographs, videotapes, recordings, or any other media (collectively “IMAGES”). The RELEASOR acknowledge that LUMBER JACK’s LODGE will own such images and further grants LUMBER JACK’S LODGE permission to copyright, display, publish, distribute, use, modify, print and reprint said IMAGES in any manner whatsoever related to LUMBER JACK’S LODGE business, including without limitation, publications, advertisements, brochures, web sites, social media pages, or other electronic displays and transmissions thereof. The RELEASOR further waives any right to inspect or approve the use of any IMAGES by LUMBER JACK’S LODGE prior to their use. The RELEASOR forever releases and holds LUMBER JACK’S LODGE harmless from any and all liability arising out of the use of any IMAGES in any manner or media whatsoever and waives any and all claims and causes of action relating to the use of the IMAGES, including without limitation, claims for invasion of privacy rights or publicity.

THE RELEASOR HEREBY AGREES that this Release of Liability Waiver and all its conditions (including the non-revocable permission to use and own any IMAGES taken by LUMBER JACK’S LODGE) extends to any minors (those between the ages of thirteen (13) and seventeen (17) years of age) that the RELEASOR includes as minors participating in the ACTIVITIES on the date as set out below.  The RELEASOR confirms that by including the minors listed on this Release of Liability Waiver and executing this agreement, he/she IS AUTHORIZED TO RELEASE, ACQUIT, AND FOREVER DISCHARGE, WITHOUT QUALIFICATION OR LIMITATION any and all claims parents, grandparents, guardians, siblings, or any other party that may be involved in the raising or well-being of any minor listed may have now and/or in the future against LUMBER JACK’S LODGE, and from any and all liability, for any personal injury, disability, paralysis, death and/or property damage, expense, and/or loss sustained by any listed minor as a result of his/her participation in the ACTIVITIES due to any cause whatsoever, including but not limited to and without limitation, negligence, gross negligence, willful misconduct, including the failure to take reasonable steps to safeguard or protect me from the risk, dangers, and/or hazards of participating in the ACTIVITIES.

Signed on:  December 11, 2019

First Participant's Name

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

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

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

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

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

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Seventh Participant's Name

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Eighth Participant's Name

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Ninth Participant's Name

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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.
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