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Inflatable Obstacle Course Liability Release Form

I HEREBY ACKNOWLEDGE AND AGREE that the inflatable obstacle course/slide and toddler inflatable of ADVENTUREPLEX, a subsidiary of Beach Cities Health District, its inflatable obstacle course and toddler inflatable, has inherent risks. I have full knowledge of the nature and extent of all the risks associated with inflatable obstacle course/slide and toddler inflatable, and have had any questions about this same explained to me, including but not limited to:

  1. All manner of injury resulting from falling off the inflatable obstacle course/slide and toddler inflatable and hitting floor surfaces, other participants and projections whether permanently or temporarily in place or on the floor.
  2. Injuries resulting from collisions with other participants or falling off the inflatable obstacle course/slide and toddler inflatable.
  3. Cuts and abrasions resulting from skin contact with the inflatable obstacle course/slide and toddler inflatable.
  4. Failure of the inflatable obstacle course/slide and toddler inflatable, mechanical blowers, tarps, nets, anchor points, or any part of the inflatable obstacle course structure or the inflatable slide structure or the toddler inflatable.
  5. The obstacle course can accommodate up to 2 children at a time, varying in ages from 3 to16, and may result in body contact with other participants (e.g. touching, grabbing, pulling, pushing) and our toddler inflatable can accommodate up to 2 children at a time from ages 0 to 5.

I further acknowledge that the above list is not inclusive of all possible risk associated with the use of AdventurePlex inflatable obstacle course/slide and toddler inflatable, and that the above list in no way limits the extent or reach of this waiver and covenant not to sue, I choose to use AdventurePlex inflatable obstacle course/slide and toddler inflatable, and agree as follows:

To waive and release any and all claims that I have or may have in the future against AdventurePlex inflatable obstacle course/slide and toddler inflatable, including their owners, operators, employees, agents and representatives, as well as the designers, manufacturers or installers of the inflatable obstacle course/slide and toddler inflatable equipment.


In consideration of my use of AdventurePlex inflatable obstacle course/slide and toddler inflatable I, the undersigned user, agree to use the AdventurePlex inflatable obstacle course/slide and toddler inflatable in accordance with its established safety policies and procedures and agree to INDEMNIFY AND HOLD HARMLESS AdventurePlex inflatable obstacle course/slide and toddler inflatable, its offices, agents, owners, and employees from any and all cause of action, claim, demands, losses or costs of any nature whatsoever arising out of or in any way relating to my use of AdventurePlex inflatable obstacle course/slide and toddler inflatable, whether asserted by AdventurePlex or any third parties who may be injured on account of or in any way relating to AdventurePlex.


This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators and assignees in event of my death.


By signing this agreement, I waive my right to bring a court action to recover compensation or obtain any other remedy for an injury to my- self of my property or my death, however caused, arising out of my use of facilities of AdventurePlex, now or anytime in the future, whether caused by the center’s negligence or that of its offices, agents, or employees.


I agree to pay for all legal fees accumulated by AdventurePlex incurred by any claims made by me or on my behalf.


I certify that I am in good health and that I have no physical limitations, which would preclude my use of the facilities. I also certify that I have sufficient health, accident liability insurance to cover any bodily injury or property damage caused to a third party as a result of my participation in this event. If I have no insurance, I certify that I am personally capable of paying any and all such expenses and liabilities.


I certify that I am a Lawful age (18 years or older) otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are legally binding and I certify that I am signing this agreement, after having carefully read it, of my own free will.



First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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IF USER IS UNDER THE AGE OF 18 YEARS OLD: PARENTS/LEGAL GUARDIAN MUST CONSENT: I, as parent or legal guardian of the above minor under 18 years of age, hereby consent to the terms and conditions set forth in this release form.


By signing below the parent or court-appointed legal guardian agrees that they are also 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*
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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