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SUMMER ESCAPE CLUB

Release & Waiver of Liability

While North Valley Escape Room, LLC facilities are inherently NOT dangerous, in consideration of my child being permitted to participate in any/all activities associated with real life escape the room games, operated by North Valley Escape Room, LLC of Anthem, Arizona, I hereby waive, release, and discharge North Valley Escape Room, LLC, its owners, officers, directors, employees, members, agents, assigns, legal representatives and successors, and all business associates and partners involved in the presentation of the above noted activity and each of them their owners, officers and employees, from all liability for or by reason of any damage, loss or injury to person and property, even injury resulting in the death of the Participant, which has been or may be sustained in consequence of the Participant’s participation in the activity described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of North Valley Escape Room, LLC.

I understand that by my child being permitted to participate in the above noted activity, there are potential risks including but not limited to:

1) Being enclosed in a reasonably small room with up to 7 unrelated people
2) Potential tight spaces and low ceilings
3) Mental stress and/or similar disorders
4) The use of simple tools and objects
5) Dim and/or flashing lighting in rooms
6) Use of fog machines
7) Potential Loud noises
8) Potential live actor interaction
9) Contact with latex materials (Big Top Circus Only)

I specifically assume all risks and hazards associated with my child's participation in summer activities, including, but not limited to, the risks associates with the novel COVID-19 or similar type virus. I understand that my child will be associating with shaff and other children. To minimize the risk, the North Valley Escape Room is taking all necessary precautionary measures in accordance with the CDC and AzDH regulations. I understand, however, that there are no precautions which can completely eliminate potential exposure, given, among other things, the relatively long incubation period, and the fact that infected persons can be asymptomatic. I understand and voluntarily assume the risk that my child may acquire COVID-19 and that COVID-19 may subsequently be transmitted from my child to me, my family and members of my household.

I acknowledge that while my child is participating in the above noted activity, they will be monitored by video/audio and may be photographed after participating in the activity described above. I hereby consent to give North Valley Escape Room, LLC, permission to allow my child's photograph to be displayed, published or distributed for promotional purposes of the North Valley Escape Room, LLC exclusively.

I acknowledge that I am monetarily liable for any intentional damage to items or items taken by my child from the North Valley Escape Room, LLC.

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 Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Please list any allergies below

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Schedule Summer Escape Club Date
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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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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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