Loading...

ACCIDENT WAIVER AND RELEASE OF LIABILITY and PHOTO RELEASE (“RELEASE”)


This Accident Waiver and Release of Liability and Photo Release (this “Release”) is made effective as of the date signed below between the participant completing this form (“Releasor”) and smash room iowa llc (“Releasee”).

Releasor is participating in one or more activities at an smash room iowa llc center (the “Event”). In consideration for participating in the Event and using the location and equipment, Releasor HEREBY ASSUMES ALL OF THE RISKS OF PARTICIPATING IN THE EVENT, including by way of example and not limitation, any risks that may arise from negligence, gross negligence, or carelessness on the part of the Releasee or other participants in the event, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of any other possible liability.
Releasor agrees to all terms of this Release and acknowledges that this Release will govern Releasor’s actions and responsibilities at the Event and that it will apply equally to any future smash room iowa llc Event(s) in which Releasor participates, regardless of whether or not Releasor is required to sign an additional Release for such future events.
Releasor is participating in this Event purely on a voluntary basis. It is for recreational purposes only and is not required, expected, or encouraged as a condition or part of Releasor’s employment or school curriculum, and is not otherwise being imposed on Releasor against their will. Releasor certifies that there are no health-related reasons or problems that preclude Releasor’s participation in this Event and that Releasor has not been advised by any medical professional not to participate in the Event or any other athletic activities.
Releasor, and anyone claiming on Releasor’s behalf, hereby release and forever discharge Releasee and its affiliates, successors, assigns, officers, employees, representatives, partners, franchisees, agents, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Event takes place, and anyone claiming through them (collectively, the “Released Parties”), in their individual and/or corporate capacities, from any and all causes of action, known or unknown, which Releasor has, had, or may in the future have against any of the Released Parties arising out of or relating to any injuries, physical or psychological, or death, sustained by Releasor in connection with Releasor’s presence in, or participation in any activity at, an smash room iowa llc center.
Releasor acknowledges, agrees, and represents that Releasor understands the nature of smash room iowa llcand that Releasor is qualified, in good health, and in proper physical condition to participate in the Event. Releasor further agrees and warrants that if at any time Releasor believes conditions to be unsafe, Releasor will immediately discontinue further participation in the Event.
RELEASOR FULLY UNDERSTANDS THAT: (a) ACTIVITIES, SUCH AS THOSE PROVIDED BY smash room iowa llc, INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my Releasor’s own actions or inaction, the actions or inaction of others participating in the Event, the condition in which the Event takes place, or THE NEGLIGENCE OF THE RELEASED PARTIES; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and RELEASOR FULLY ACCEPTS AND ASSUMES ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES Releasor may incur as a result of Releasor’s participation in the Activity.
RELEASOR HEREBY RELEASES, DISCHARGES, AND COVENANTS NOT TO SUE THE RELEASED PARTIES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND RELEASOR FURTHER AGREES that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, RELEASOR, or anyone on Releasor’s behalf, makes a claim against any of the Released Parties, RELEASOR WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.
Releasor hereby consents to receive medical treatment, which may be deemed advisable in the event of injury, accident, and/or illness during the Event (including during travel to and from the Event). For the sake of clarity, any decision or act by any Released Party to provide, request, or otherwise induce the provision of any medical treatment to Releasor as a result of an injury, accident, or illness during the Event shall be covered by this Release.
Releasor understands that, while on the premises or participating in the Event, Releasor may be photographed or subject to audio and/or video recording. Releasor hereby grants to Releasee the rights of any image, in video or still, and the likeness and sound of Releasor’s voice as recorded on audio or video, without payment or any other consideration. Releasor understands that any image or recording may be edited, copied, exhibited, published, or distributed for any legitimate purpose including commercial purposes, and Releasor waives the right to inspect or approve the finished product wherein Releasor’s likeness appears. Additionally, Releasor waives any right to royalties or other compensation arising or related to the use of Releasor’s image or recording.
RELEASOR: (i) HAS READ THIS AGREEMENT, (ii) FULLY UNDERSTANDS ITS TERMS, (iii) UNDERSTANDS THAT RELEASOR HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, (iv) HAS SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE, (v) INTENDS IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW, AND (vi) AGREES THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

 

Waiver, Rules, & Polices
Participation Waiver, Smash Room Iowa LLC

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT (Hereinafter the “Release Agreement”). BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT. PLEASE READ CAREFULLY!

TO: Smash Room Iowa LLC and their respective directors, officers, employees, guides, agents, representatives, volunteers, independent contractors, subcontractors, sponsors, successors and assigns (all of whom are hereinafter collectively referred to as the “Releasees”).

ASSUMPTION OF RISKS

I am aware that participating in a rage room involves unusual risks, dangers and hazards including, but not limited to: accidents which may occur in the facility; slips and falls; malfunction of the equipment used; injury and open wounds; shock, stress or other injury to the body while participating in the rage room; negligence on the part of other persons; and NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF THE RAGE ROOM. I acknowledge that the use of Smash Room Iowa LLC’s Rage Room may result in injury, worsening of an existing medical condition, or death. I freely accept and fully assume all such risks, dangers and hazards and the possibility of injury, death, property damage or loss resulting therefrom.

MEDICAL CONDITION

I understand that use of the rage room may place unusual stresses on the body. Use of rage rooms are not recommended for persons suffering from asthma, epilepsy, cardio/respiratory disorder, hypertension, or skeletal, joint or ligament problems or conditions, and certain mental illnesses. Women who are pregnant or suspect they are pregnant, and persons who have consumed alcohol, are not recommended to engage in the rage room. I have been advised to consult with my medical practitioner if I have any concern about my medical condition or fitness to engage in the rage room.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of the Releasees agreeing to my participation in the rage room, and permitting my use of the Smash Room Iowa LLC’s equipment, room and other facilities, I hereby agree as follows:

TO WAIVE ANY AND ALL CLAIMS AND TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer, as a result of my participation in the rage room, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES THE FAILURE ON PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF SMASH ROOM IOWA;
TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any property damage or personal injury to any third party resulting from my participation in the Rage Room;
This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;
This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Smash Room Iowa LLC and no other jurisdiction;
Any litigation involving the parties to this Release Agreement shall be brought solely within the City of Des Moines and shall be within the exclusive jurisdiction of the Courts of the State of Iowa.

PHOTO/VIDEO RELEASE – I consent to photographs and videos being taken of me during my participation in the rage room, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing purposes.

In entering into this Release Agreement I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of the rage room, other than what is set forth in this Release Agreement.

 

Rules

Never remove your safety equipment whilst in the Smash Room Iowa LLC.
Do not attempt to lift any large item or broken glass items or potentially rusty metal objects.
Do not jump or climb on any item.
Do not break or kick items with your feet.
Be safe and have a smashing good time.
Must wear closed toed shoes, no flip-flops (splatter room exempt).
Must wear protective gear (coveralls, goggles, gloves, face shields)

Only one person in the axe throwing lanes at a time

Wait for axe to stop on the ground or board before passing red line on floor

Always pass axes by setting axe on the ground against the wall and allwoing other person to pick up on there own

Do not run with paint brushes in hand

 

Once a session is booked through the fareharbour system, refunds will only be given in the form of a non expiring gift card code that the customer can use at there discretion and rebook online. Must give 24 hour notice to receive a refund credit, pending manager approval if after 24 hours.

 

I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT PRIOR TO SUBMITTING IT, AND I AM AWARE THAT BY SIGNING THIS RELEASE AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

 

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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!