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BADLANDS, LLC.  ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

 

BADLANDS, LLC. ADULT ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I hereby consent to participation in recreational activities and use of the space known as Badlands (“the Facility”) located at 5200 Randolph Road, Rockville, MD 20852 and operated and maintained by Badlands, LLC. I acknowledge that this Accident Waiver and Release of Liability Form (“Agreement”) will be used by Badlands, LLC and others, and that it will govern my actions and responsibilities, and those of my child/children, at the Facility.

I acknowledge that I have read, understood and I voluntarily agree, individually and on behalf of myself, to abide by all rules and regulations as posted in the Facility. I further voluntarily agree to abide by any instruction or direction given to me by any staff member or employee of the Facility.

I acknowledge that participation of activities offered by or through the Facility and use of the Facility 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. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THE FACILITY, 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, for myself, my child/children or ward/wards acknowledge by accepting this waiver that I grant the Facility and its authorized representatives' permission to record on photography film and/or video, pictures of my/our participation. I further agree that any or all material photographed may be used, in any form, as part of future publications, brochures, or other printed materials, and social media, used to promote Badlands, LLC and further that such shall be without payment of fees, royalties, special credits or discounts to Facility or other compensation.

In consideration for use of the Facility and services and activities offered by or through the Facility, I do hereby waive, release and forever discharge from liability: Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, shareholders, successors, and assigns from any and all claims and causes of action of any kind or nature which are in any way related, directly or indirectly, to the use of the Facility or participation in any activity offered by or through the Facility which I may have or that hereafter may accrue including any such claims or causes of action caused in whole or in part by the negligence of Badlands, LLC, its subsidiaries and affiliates, and their respective agents, employees, officers, directors, successors, and assigns. I understand that I am here at my own risk and expense and agree I will not bring any claim or cause of action of any kind or nature against Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors and assigns.

I further agree to indemnify, defend and hold harmless Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors, and assigns from any claims or causes of action of any kind arising from my use of the Facility or any participation or activity offered by or through the Facility. By accepting below, I acknowledge and agree that I have read this Waiver/Agreement, understood all of the terms and conditions contained herein, and that this Waiver/Agreement will be in full force and effect during each of my or my child's/children visit to the Facility. This Waiver/Agreement shall remain in full force and effect at all times I am present at the Facility, or participating in a service offered by or through the Facility. 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY ON BEHALF OF MYSELF AND A MINOR CHILD/CHILDREN, AND I ACCEPT THE TERMS OF THIS WAIVER OF MY OWN FREE WILL.

BADLANDS, LLC. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM (on behalf of a Minor Child/Children) 

 

I hereby certify that I am the adult parent or guardian of a minor child/children under the age of eighteen (18) years (the “Minor Child/Children”), and I consent to his/her participation in recreational activities and use of the space known as Badlands (“the Facility”) located at 5200 Randolph Road, Rockville, MD 20852 and operated and maintained by Badlands, LLC. I acknowledge that this Accident Waiver and Release of Liability Form (“Agreement”) will be used by Badlands, LLC and others, and that it will govern my actions and responsibilities, and those of my Child/Children, at the Facility. I acknowledge that I have read, understood and I voluntarily agree, individually and on behalf of myself and Minor Child/Children, to abide by all rules and regulations as posted in the Facility. I further voluntarily agree, individually and on behalf of myself and Minor Child/Children, to abide by any instruction or direction given to me by any staff member or employee of the Facility. I acknowledge that participation of activities offered by or through the Facility and use of the Facility 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. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I HEREBY ASSUME, ON BEHALF OF MYSELF AND MINOR CHILD/CHILDREN, ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THE FACILITY, 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. In consideration for use of the Facility and services and activities offered by or through the Facility, I, individually and on behalf of my Minor Child/Children, do hereby waive, release and forever discharge from liability: Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, shareholders, successors, and assigns from any and all claims and causes of action of any kind or nature which are in any way related, directly or indirectly, to the use of The Facility or participation in any activity offered by or through the Facility which I may have or that hereafter may accrue including any such claims or causes of action caused in whole or in part by the negligence of Badlands, LLC, its subsidiaries and affiliates, and their respective agents, employees, officers, directors, successors, and assigns. I understand that my Minor Child/Children is here at my own risk and expense and agree that neither I nor my Minor Child/Children will bring any claim or cause of action of any kind or nature against Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors and assigns. 

I further agree to indemnify, defend and hold harmless Badlands, LLC, its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors, and assigns from any claims or causes of action of any kind arising from me or my Minor Child’s/Children use of the Facility or any participation or activity offered by or through the Facility. By accepting below, I acknowledge and agree that I have read this Waiver/Agreement, understood all the terms and conditions contained herein, and that this Waiver/Agreement will be in full force and effect during each of my Minor Child's/Children visit to the Facility. This Waiver/Agreement shall remain in full force and effect at all times whether my Minor Child/Children is present at the Facility with or without me, or with any other parent or guardian, or participating in a service offered by or through the Facility. 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY ON BEHALF OF MYSELF AND A MINOR CHILD/CHILDREN, AND I ACCEPT THE TERMS OF THIS WAIVER OF MY OWN FREE WILL.

July 3, 2020

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone 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*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's 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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