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FORM OF WAIVER AND ASSUMPTION OF RISK AGREEMENT

This Waiver and Assumption of Risk Agreement (this “Agreement”) is dated as of January 25, 2020 for the benefit of Snapology of Lancaster and Reading. (“Snapology”).

Participant desires to participate in educational, physical and entertainment related activities (the “Activities”) provided by Snapology. Food, including items containing certain allergens such as peanuts, may be provided by Snapology or brought into the facility by other participants during certain Activities. In consideration of being allowed to use the facilities and participate in the Activities provided by Snapology, Participant, or if Participant is less than 18 years of age, Participant's parent or guardian, on behalf of themself and Participant, agrees, to the fullest extent permitted by law, as follows:

TO WAIVE ALL CLAIMS that they have or may have against Snapology arising out of Participant’s participation in the Activities or the use of any building blocks or other equipment (“Equipment”), including while receiving instruction and/or training;

TO ASSUME ALL RISKS of participating in the Activities and using the Equipment, even those caused by the negligent acts or conduct of Snapology, its owners, affiliates, operators, employees, agents, and/or officers. Participant and his/her parent(s) or legal guardian(s) understand that there are inherent risks of participating in the Activities and using the Equipment, which may be both foreseen and unforeseen;

TO RELEASE Snapology, its owners, affiliates, operators, employees, agents, and officers from all liability for any loss, damage, injury, death, or expense that Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. Participant and his/her parent(s) or legal guardian(s) specifically understand that they are releasing any and all claims that arise or may arise from any negligent acts or conduct of Snapology, its owners, affiliates, operators, employees, agents, and/or officers, to the fullest extent permitted by law. However, nothing herein shall be construed as a release for conduct that is found to constitute gross negligence or intentional conduct;

TO INDEMNIFY Snapology, its owners, affiliates, operators, employees, agents, and/or officers, from all liability for any loss, damage, injury, death, or expense that Participant (or his/her next of kin) may suffer, arising out of participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training;

TO AGREE TO BE RESPONSIBLE for any medical bills related to treatment of any illness or accident sustained while at a Snapology program. Participant and his/her parent(s) or legal guardian(s) hereby consents to allow any Snapology supervisor to procure any medical treatment deemed advisable on behalf of Participant without prior consent. Snapology does not provide medical insurance.

This Agreement and the rights and obligations of the parties hereunder shall be governed by, construed and enforced in accordance with the laws of the Commonwealth of Pennsylvania, without regard to its conflicts of law principles. The parties hereto hereby agree that the indemnification and release contained herein shall continue for each and every program in which Participant participates. The parties hereto shall use their best efforts to take such actions as may be necessary or reasonably requested by the other party hereto to carry out and consummate the transactions contemplated hereunder. This Agreement may be modified, amended, discharged or waived only by an agreement in writing signed by the party against whom enforcement of any such modification, amendment, discharge or waiver is sought.

Acknowledged, agreed to and accepted by:

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
First Participant's Signature*
Second Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Third Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Fourth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Fifth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Sixth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Seventh Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Eighth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Ninth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Tenth Participant's Name

First Name*

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

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
Participant's 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*

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 Information

Food Allergies or Restrictions
CHECK HERE TO WAIVE OWNERSHIP of any photographic records taken by or on behalf of Snapology and agree to permit Snapology to use Participant's image in photographic, digital, or electronic format, for and in publications, brochures, website, or other media, without limitation, and agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against Snapology in respect thereof. Participant and his/her parent(s) or legal guardian(s) also understand that Snapology may provide such photographs for use by a third party with whom Snapology may choose to associate with for joint marketing purposes (i.e., a community recreation center, school or business where Snapology activities are being co-promoted).
Waiver Ownership
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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