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LAZERLAND

a dba of Xplore Laser Tag, Inc

   PARTICIPANT AGREEMENT, ACKNOWLEDGEMENT OF RISK, ASSUMPTION

OF RISK, RELEASE OF LIABILITY AND CONSENT TO USE OF LIKENESS AND PHOTOGRAPHS NOTICE: READ THIS FORM COMPLETELY AND CAREFULLY

PLAY AT YOUR OWN RISK

 

 In consideration of being allowed to use the facility and to participate in the services and activities, including, but not limited to dodge ball, basketball, laser tag, buble soccer, snack bar access, party room access, arcade games, and any other amusement and entertainment activities (collectively, “ACTIVITIES”) provided by Xplore Laser Tag, Inc. located at 54A Motor Parkway, Commack, NY 11725 (“LAZERLAND”), its agents, owners, affiliates, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf I, on behalf of myself, and/or on behalf of my minor child(ren)/ward(s), and on behalf of any minor on whose behalf I sign this Agreement (collectively, “CHILD”), hereby acknowledge, affirm, and agree to the following:

(1) AFFIRMATION OF AUTHORITY: I hereby represent and affirm that I have the legal authority to sign this Agreement on behalf of any CHILD whose name appears on this Agreement. I further acknowledge, understand and appreciate that LAZERLAND is relying upon this representation in allowing any such CHILD to participate in the ACTIVITIES.

(2) ACKNOWLEDGEMENT, UNDERSTANDING AND APPRECIATION OF THE RISKS: I acknowledge, understand and appreciate that my participation, and/or the participation of my CHILD in the ACTIVITIES entails known as well as unanticipated risks that could result in death, serious physical or emotional injury, paralysis, or damage to me, my CHILD, to property, or to third parties. I further acknowledge, understand and appreciate that such risks simply cannot be eliminated without jeopardizing the essential qualities of the ACTIVITIES. These risks include, among other things: slipping and falling; collision with fixed objects or people; injuries caused by stepping on or falling on equipment or items that have fallen from or were dropped by myself, my CHILD, another participant, or anyone else; injuries including, sprains, fractures, scrapes, bruises and cuts, dislocations, pinched fingers and serious injuries to the head, back, or neck; injuries arising out of the negligence of or otherwise caused by other participants, myself, my CHILD, or anyone else; injuries due to the physical or mental condition or any medical condition that I and my CHILD may have whether known or unknown; injuries due to physical contact with others, including the risk of contracting illness or coming into contact with germs, bacteria or fungi whether by contact with equipment or with another participant or anyone else, and any and all risks associated with exercise, physical exertion and physical activities (hereinafter collectively referred to as the “RISKS”). 

(3) ASSUMPTION OF THE RISKS: I expressly agree and promise to accept and assume all of the RISKS arising from my and my CHILD’s participation in the ACTIVITIES. My and my CHILD’s participation in the ACTIVITIES at LAZERLAND is purely voluntary, and I and my CHILD elect to participate in spite of the RISKS. 

(4) RELEASE OF LIABILITY: I hereby forever, irrevocably and unconditionally release, waive, relinquish, discharge from liability and covenant not to sue LAZERLAND, and their successors, predecessors-in-interest, and insurers (collectively, the “RELEASEES") from any and all claims, demands, rights, actions, suits, causes of action, obligations, debts, costs, losses, charges, expenses, attorneys’ fees, damages, judgments and liabilities, of whatever kind or nature, in law, equity or otherwise, whether now known or unknown, suspected or unsuspected, and whether or not concealed or hidden, related to or arising,
directly or indirectly, from my and/or my CHILD’s access to and/or use of the LAZERLAND facility, premises and/or its equipment, my and/or my CHILD’s entry into the LAZERLAND, the condition, maintenance, inspection, supervision, control or security of the LAZERLAND facility, the failure to warn of dangerous conditions in connection with LAZERLAND, and/or the acts or omissions of LAZERLAND or any of the RELEASEES, including, without limitation, any claim for negligence, gross negligence, failure to warn or other omission, property damage, personal injury, emotional injury, illness, bodily harm, paralysis or death. I understand that this release and waiver applies to all equipment, and all activities and games at the LAZERLAND facility. I understand that this release and waiver applies to and includes all activities that I and/or my CHILD engage in at the premises, whether inside or outside the LAZERLAND facility.

(5) INDEMNIFICATION: In recognition of the RISKS and death identified above, I accept full financial responsibility for any injury or death I and/or my CHILD may cause to themselves or to any other person due to my and/or my CHILD’s negligence and/or intentional acts or omissions. I agree to indemnify and hold harmless LAZERLAND and any other RELEASEES from liability for the injury or death of any person(s) and damage to property that may result from my and/or my CHILD’s negligent or intentional acts or omissions while participating in the ACTIVITIES.

(6) ATTORNEYS’ FEES, INSURANCE: Should LAZERLAND or anyone acting on its behalf, be required to incur attorneys’ fees and costs to enforce this Agreement, including but not limited to, attorneys’ fees and costs incurred to defend against claims brought by me or my CHILD, or by third parties arising out of my or my CHILD’s negligence or intentional acts or omissions, I agree to indemnify and hold LAZERLAND or anyone acting on its behalf harmless for all such fees and costs. I warrant that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in the ACTIVITIES, or else I agree to bear the costs of such injury or damage myself.
                                                                                                                                                                                         
(7) PHOTO RELEASE: By entering LAZERLAND and participating in the ACTIVITIES, I hereby grant LAZERLAND on behalf of myself and my CHILD the irrevocable right and permission to photograph and/or record me or my CHILD in connection with LAZERLAND and to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner and in any media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of the photograph and/or recording, and acknowledge and agree that the rights granted to this release are without compensation of any kind. 

(8) APPLICABLE LAW/VENUE/ARBITRATION: Any controversy between the parties hereto involving any claim arising out of or relating to use of the facilities, participation in the ACTIVITIES, or otherwise arising out of or relating to this Agreement shall be submitted to and be settled by final and binding arbitration in Suffolk County, New York, in accordance with the then current Commercial Arbitration Rules of the American Arbitration Association. In the event of litigation to enforce arbitration or settlement between the parties to this Agreement, or in the event arbitration is not available, then I agree to venue in the Courts of Suffolk County in the State of New York. I agree that the substantive law of New York shall apply in that action without regard to the conflict of law rules of that state, and I agree to, and hereby do, waive the right to a trial by jury. 

(9) SEVERABILITY: I agree and understand that this Agreement is intended to be as broad and as inclusive as permitted by law in the State of New York and if any portion of this Agreement is found to be void or unenforceable, then the remaining document shall remain in full force and effect. (10)NO OTHER REPRESENTATIONS, WARRANTIES, PROMISES, ETC.: I understand and affirm that there are no other representations, warranties, promises, understandings, etc., written or oral, regarding the subject matter of this Agreement, and that I will bound by the terms of this Agreement. I further understand that any amendment, change, or modification of this Agreement must be in writing and signed by LAZERLAND in order to change any term contained herein.

NOTICE TO THE MINOR CHILD’S PARENT OR NATURAL GUARDIAN 

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF LAZERLAND AND ALL OTHER RELEASEES USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM LAZERLAND AND ALL OTHER RELEASEES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND LAZERLAND AND ALL OTHER RELEASEES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

 

By signing below, I affirm, understand and agree to the above terms in their entirety.

First Participant/Guardian Name

First Name*

Last Name*

Phone*
First Participant/Guardian Date of Birth*
I certify that I am 18 years of age or older
First Participant/Guardian Signature*
Second Participant/Guardian Name

First Name*

Last Name*
Second Participant/Guardian Date of Birth*
Third Participant/Guardian Name

First Name*

Last Name*
Third Participant/Guardian Date of Birth*
Fourth Participant/Guardian Name

First Name*

Last Name*
Fourth Participant/Guardian Date of Birth*
Fifth Participant/Guardian Name

First Name*

Last Name*
Fifth Participant/Guardian Date of Birth*
Sixth Participant/Guardian Name

First Name*

Last Name*
Sixth Participant/Guardian Date of Birth*
Seventh Participant/Guardian Name

First Name*

Last Name*
Seventh Participant/Guardian Date of Birth*
Eighth Participant/Guardian Name

First Name*

Last Name*
Eighth Participant/Guardian Date of Birth*
Ninth Participant/Guardian Name

First Name*

Last Name*
Ninth Participant/Guardian Date of Birth*
Tenth Participant/Guardian Name

First Name*

Last Name*
Tenth Participant/Guardian Date of Birth*
Participant/Guardian 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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
FOR BIRTHDAY PARTIES/GROUPS/CAMPS ONLY! Please enter the party/group/camp unique number provided by your host/coordinator.

Enter unique party or group reference number
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.


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