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Axe Throwing Agreement, Assumption of Risk, and Waiver of Liability

Please read carefully!!  By signing or initialing this document you are agreeing to waive your legal rights, including the right to sue.

I hereby certify that I wish to participate in axe throwing at Southern Illinois Axe & Ale LLC, 35 South Vine Street, Harrisburg, IL 62946 at my own risk.

I fully understand and acknowledge the inherent risks associated with the throwing of, or use of, axes of any size or kind; the potential dangerous nature associated with the throwing of, or use of, axes of any size, or kind or other throwing item such as throwing knives, cards, etc; the potential hazardous risks associated with the throwing of, or use of, axes of any size, or kind or other throwing item such as throwing knives, cards, etc; and/or the potentially dangerous environment that can be caused to myself, and/or to others, from the misuse, or throwing of axes of any kind, or size or other throwing item such as throwing knives, cards, etc.

I believe that I am physically, emotionally & mentally able to participate in axe throwing.

I agree that I will follow all applicable rules for participating in axe throwing and that at all times the sole responsibility for my personal safety remains with me.

If at anytime I sense or observe a violation of the applicable rules or something that appears to be unusually hazardous or unsafe I will immediately remove myself the area and notify the nearest official.

I agree that Southern Illinois Axe & Ale LLC, its members, employees, or agents, reserve the right to refuse entry, suspend, or cancel any axe throwing activities at any time and for any reason including but not limit to failure to follow all applicable rules.  I understand that I will not receive a refund or may not be allowed to return in the future. 

I release from, waive, and discharge all actions, claims, or demands that I, my assignees, heirs, guardians, and legal representatives now have or hereafter have for damage or losses on account of injury, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligence or other acts of Southern Illinois Axe & Ale LLC, its members, employees, or agents, as a result of my participation in any axe throwing related activities. I hereby agree and covenant to save and hold harmless, indemnify, and defend any claim against Southern Illinois Axe & Ale, LLC, its members, employees, or agents, as a result of my participation in any axe throwing related activities.

I agree that neither myself, nor my assignees, heirs, guardians, and/or legal representatives will sue Southern Illinois Axe & Ale LLC, its members, employees, or agents as a result of my participation in any axe throwing activities.

I hereby consent to received medical treatment that may be deemed advisable in the event of injury, accident, and/or illness.

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be videotaped, edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.

I understand and agree that this agreement, assumption of risk, and waiver of liability will remain on file and apply whenever I am on the premises.

By entering into this agreement, I am not relying on any oral or written representations or statements made by Southern Illinois Axe & Ale, LLC other than what is set forth in this agreement. If I do not feel that I can fully, competently, emotionally, and mentally adhere to each and every article above or do not feel comfortable with any part of this agreement I will not sign or participate in any axe throwing.

I HAVE CAREFULLY READ THE ABOVE AXE THROWING AGREEMENT, ASSUMPTION OF RISK, AND WAIVER OF LIABILITY AND FULLY UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT AND I DO SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I ACKNOWLEDGE READING THE RULES OF SOUTHERN ILLINOIS AXE & ALE AND AGREE TO ABIDE BY THEM.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
City/State

City *

State *
I certify that I am the parent/guardian with legal responsibility for the minor(s). I agree that all the terms & conditions of this agreement apply to both the minor(s) and myself, and I am signing this agreement on behalf of the minor(s) and myself and agree to their participation even when I may not be present.
Parent or Guardian's Name

First 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.


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