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RELEASE OF LIABILITY, WAIVER, ASSUMPTION OF RISK AND HOLD HARMLESS AGREEMENT

FOR ENTERING AXE-THROWING AREA OF HARI PALACES, INC., D/B/A THOMASVILLE PIN SPLIT AT 1650 COLONIAL DRIVE, THOMASVILLE, GA 31757

I, the undersigned “Customer”, understand that Hari Palaces, Inc., d/b/a Thomasville Pin Split (“Proprietor”), is the owner and operator of a business conducted at 1650 Colonial Drive, Thomasville, GA 31757 which includes bowling alleys, video games, arcade, axe throwing and bar.  I am signing this Release of Liability, Waiver, Assumption of Risk and Hold Harmless Agreement, in order to induce the proprietor, Hari Palaces, Inc., to allow me access to the axe throwing area, whether or not I choose to participate in the actual activity of axe throwing.  I assume the risk of entering the axe throwing area and of participating in that activity, and waive my right and any right of my heirs, successors, administrators or assigns to make any claim against or sue the proprietor or its officers or employees or owners for any personal injury or wrongful death suffered by me as a result of my choice to assume the risk, and swear or affirm and agree to all of the following:

1. I am over the age of 21 years and fully competent to waive legal rights.  Notwithstanding the fact that I will pay a fee for the opportunity to enter the premises, I have been advised that axe throwing is an inherently dangerous activity and that, being in the same area or vicinity as persons who are engaged in the activity of axe throwing, subjects me to an increased risk and danger of personal injury or wrongful death.

2. I am in good health and able to participate in and withstand the stress of axe throwing and have the athletic ability to do so without endangering myself or others.

3. I accept the risk that the axe throwing activity is in the same area of the building as the bar at which alcoholic beverages are served and consumed.

4. I understand and accept the risk that others who are engaging in axe throwing may have consumed alcoholic beverages, medicines, or other substances that may impair their judgment and contribute to me being endangered.

5. I assume the risk that persons in the axe throwing area or participating in the axe throwing activity may have consumed prescription or other drugs which may also affect and impair their judgment and result in them acting in a dangerous manner.

6. I understand and accept the risk that, notwithstanding the intention of the proprietor to exercise due care and to advise and require other patrons and customers who enter the axe throwing area to obey the rules, some persons may choose not to obey the rules and may act in a dangerous manner in the axe throwing area.

7. I understand and accept the risk that if I consume alcoholic beverages, take medicines, or use substances that could impair my judgment, and engage in the activity of axe throwing, or enter the axe throwing area, it may impair my judgment and result in me subjecting myself or others to danger of injury or wrongful death.

8. I swear or affirm that I am not under any prescription medicine and have not consumed any drugs or medicine including alcohol that would impair my judgment or ability to follow the rules and conduct myself in a safe and reasonable manner while in the axe throwing area.

9. Should I see or become aware that anyone is acting in a dangerous manner in the axe throwing area, I agree to exit the area myself and to make that situation known as soon as possible to representatives of the proprietor.

10. I acknowledge that by entering the axe throwing area, I am subjecting myself to an increased risk of danger from being in the area where others are engaging in an inherently dangerous activity, and that I myself may be engaged in an inherently dangerous activity including the possibility of the axe slipping when I am attempting to throw it and hitting me or otherwise causing me injury.

11. I understand all of the foregoing and agree to assume the risk and to hold harmless and indemnify and defend Hari Palaces, Inc., d/b/a Thomasville Pin Split, Proprietor, and the officers and owners of the corporation, individually, from any liability for personal injury or wrongful death experienced by me while in the axe throwing area or as a result of my having been in the axe throwing area of Hari Palaces, Inc.

12. I specifically understand and agree that, in the event that I or anyone in my behalf commences any legal action or proceedings or makes any claim for injury or wrongful death that has occurred on the premises of the proprietor, this document, which I have either electronically or personally signed, may be entered in evidence as proof that I have waived and given up any right to claim liability against Hari Palaces, Inc., its officers, owners, or employees.  In the event that the proprietor or any of its officers or employees are added to any action or proceeding in which I am a participant, I understand that I will be liable, based upon this document, for the legal costs incurred by the proprietor in defending against the proceeding.

13. As between the proprietor and me, I agree to be fully responsible for all costs and expenses that may be incurred and any travel, medical attention, or other expenses related to any personal injury or wrongful death sustained by me as a result of entering the inherently dangerous premises of the axe throwing area of the proprietor.  I will indemnify and hold harmless the proprietor, its officers and agents, from any such liability, even if I make a claim against a third party for a wrongful or negligent act by him or her that injures me.

14. This Release of Liability, Waiver, Assumption of Risk and Hold Harmless Agreement may be pleaded in the event of any claim, action, complaint or proceeding for injury or death sustained by me, as a complete defense and reply, and may be relied upon in any such proceeding by the proprietor, its officers, employees, attorneys and agents to dismiss the claim, action, complaint or proceeding on a summary basis.

15. The foregoing Release of Liability, Waiver, Assumption of Risk and Hold Harmless Agreement contains the entire agreement between me and the proprietor, and there have not been any verbal assurances or other explanations that would lead me to believe that this Agreement is not legally binding as a release of liability, waiver, and assumption of risk and hold harmless agreement.

16. If I have executed this Release of Liability, Waiver, Assumption of Risk and Hold Harmless Agreement by an electronic means, I consent and acknowledge that it will be as binding as if I had personally signed it before a witness and notary public.

Today's date: May 18, 2021

First Participant's Name

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I certify that I am 21 years of age or older
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Second Participant's Name

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

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

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Fourth Participant's Date of Birth*
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Sixth Participant's Name

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Seventh Participant's Name

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Eighth Participant's Name

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

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Tenth Participant's Name

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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

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Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 21 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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