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ACKNOWLEDGEMENT AND ASSUMPTION OF RISK;
STATEMENT OF COMPLIANCE WITH TERMS AND CONDITIONS;
RELEASE OF LIABILITY;
WAIVER OF CLAIMS;
INDEMNIFICATION;
AND IMAGE RELEASE


BY SIGNING THIS ACKNOWLEDGEMENT AND ASSUMPTION OF RISK; STATEMENT OF COMPLIANCE WITH TERMS AND CONDITIONS; RELEASE OF LIABILITY; WAIVER OF CLAIMS; INDEMNIFICATION; AND IMAGE RELEASE (hereinafter “Agreement”), YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT OR INJURY. PLEASE READ CAREFULLY!

TO: Birmingham Rage Room and Games LLC (“Birmingham Rage Room,” and any and all of its related entities, together with any of their respective managers, directors, officers, owners, employees, investors, advisors, advertisers, agents, volunteers, vendors, contractors, landlords, lessors, lenders, sponsors, successors and assigns (all of whom are hereinafter collectively referred to as the “Releasees”).

In consideration of my being allowed to be present at the Birmingham Rage Room and to participate in activities offered by the Birmingham Rage Room and to use the services, equipment, property, facilities and premises belonging to or under the control of the Birmingham Rage Room, together with all related preparation, unequipping, and other activities related to or arising in connection with such participation or use (all of the aforementioned being referred to collectively herein as “Participation”), I, for myself and for each minor for whom I am parent or guardian as indicated herein (“I,” “me”, or “my,”) hereby acknowledge and agree as set forth herein, including, without limitation, that I acknowledge and assume all risks of Participation; that I am now in compliance and will comply with all terms and conditions herein and referenced and/or incorporated herein; that I release and hold the Releasees harmless as specified herein, that I waive claims as set forth herein; that I indemnify the Releasees as set forth herein; and that I consent to release of my image and likeness as set forth herein:


ASSUMPTION OF RISKS

I fully understand and acknowledge that Participation is inherently dangerous, and that Participation involves unusual risks, dangers and hazards, including, but not limited to:

a. Any and all manner of injury or accident, including without limitation the possibility of serious injury or death, resulting from, arising from, or in connection with, Participation;

b. Cuts, scrapes, abrasions, burns, blisters, or rashes;

c. Slips and/or falls;

d. Illness, disease or infection;

e. Shock, stress, emotional injury and/or psychological trauma;

f. Anticipation of immediate personal danger or injury;

g. Inadvertent and/or unwelcome touching/contact;

h. Strain upon, sprain, or tearing of muscles or ligaments; bruises and/or tissue injury;

i. Fractured or broken bones;

j. Neurological injury;

k. Injury to internal organs;

l. Injury to the eyes, ears or nose;

m. Cosmetic injury;

n. Cardiac or respiratory distress and/or injury;

o. Concussion, disability, and paralysis;

p. Aggravation or worsening of any existing medical condition

q. Any other bodily or personal injury or accident resulting from or arising in connection with falling, tripping; contact with floors, equipment, fixtures, people, items or debris; failure to use or properly use protective gear or equipment; unavailability of immediate medical attention or assistance; flying debris, items or implements; acts or omissions of others; skin contact with equipment, items, debris, or any other surface, person, or equipment; failure to inspect,or failure, malfunction or misuse of, safety equipment or any other items or equipment; latent or apparent defects in equipment, items or premises; failure to follow instructions or failure to ask for information or assistance; touching, collisions; my own actions, inactions and/or negligence; and NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES, WITHOUT LIMITATION, FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF Participation.

I further acknowledge that the above list is not inclusive of all possible inherent risks associated with Participation, and I agree that such list in no way limits the extent of my assumption of of risk, release, or indemnification. I understand there may be other risks not known to me or reasonably foreseeable at this time; I have considered the risk involved and freely accept and fully assume all such risks, dangers and hazards and the possibilities of bodily or personal injury, death, property damage or other loss resulting therefrom.

I acknowledge I am engaging in Participation knowingly and voluntarily. I have the right to discontinue or terminate my Participation for any reason, and at any time, without a refund.


TERMS AND CONDITIONS

Medical Conditions; Intoxication and Medication; Exposure

I understand, acknowledge and agree that Participation may place unusual stresses on the body, and is not recommended for persons suffering from asthma, certain allergies, epilepsy, cardio/respiratory disorder, hypertension, or skeletal, joint or ligament problems or conditions, and certain mental illnesses. I understand, acknowledge and agree that Participation is not recommended for women who are pregnant or suspect they are pregnant, and persons who have consumed alcohol or are otherwise intoxicated.

I certify that I have no medical or physical conditions which interfere with my ability to safely engage in Participation, or that I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition. I am free to and will consult with my medical practitioner if I have any concern about my medical or mental condition, medication, or fitness to engage in Participation prior to engaging in the same.

I hereby make the affirmative representation that I am not under the influence of any intoxicating beverage, substance, or medication during, or at any time relevant to, my Participation. This includes any medication that may inhibit motor skills or cognitive ability, blood alcohol .08 or above (the set illegal limit to operate a vehicle), or ANY illegal drug, substance, or non prescribed medication. I also understand that if I am on any medication (prescription or over-the-counter) I have read and understand the labels, side effects, and warnings thoroughly and consulted a medical professional on how the medication may affect me during Participation at the Birmingham Rage Room. I acknowledge and agree that the Birmingham Rage Room has the right to refuse to allow me to Participate or to discontinue or terminate my Participation if they suspect that I am inebriated, intoxicated, or otherwise under the influence of alcohol or drugs, or present a danger to myself or others, or for any other or no reason.

To the best of my knowledge, I have not been in close contact with a confirmed case of COVID-19 within the last two weeks; am not currently experiencing a cough, shortness of breath, or sore throat; and have not had a fever in the last 48 hours.


Rules and Safety

Before Participation I have watched the safety and rules video or read the rules and safety instructions online at the Birmingham Rage Room’s website or in person at the Birmingham Rage Room property. I agree to obey all stated and posted instructions, rules, and conditions during my Participation, and will remove myself from Participation and contact a representative of the Birmingham Rage Room if I observe any unusual significant hazard related to Participation. I agree to inspect all equipment provided to me before use, that I will report any concerns regarding the same prior to use, and that I will obtain a suitable replacement for the same if necessary prior to use. I also understand I may ask a staff member any additional questions I have in regards to rules or safety before I begin any activity. I understand that if I have any questions or need additional help with putting on/fitting safety equipment I will find a staff member to help check that safety equipment is properly on before beginning. I understand that if I do not have, or if I refuse to use, safety equipment, or if my safety equipment does not fit properly, that I will not be allowed to engage in Participation. I understand that if I have a concern about any safety equipment being able to fit me I have the option to come before my session to see if the safety equipment will fit, and that I may engage in Participation using my own equipment I have provided so long as it complies with all rules as stated for the safety equipment standards and is approved by a staff member. I understand and acknowledge that any safety rules or instructions adopted or provided by the Birmingham Rage Room to me, and safety equipment installed or provided to me, may mitigate risk but cannot eliminate risk. I agree to abide by the rules set forth by Birmingham Rage Room and agree that if I or a member of my group is breaking any of these safety rules a staff member may remove the person breaking the rules from the session or the entire group at any time with no refund. I also understand that breaking these rules can result in a lifetime ban from the Birmingham Rage Room. I agree that if I notice anything unsafe, unusual, or concerning while engaging in Participation I will stop what I am doing and notify a staff member immediately.  

I understand that in order to engage in Participation I may be required to show my photo ID to be verified by a staff member.


RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In further consideration for my Participation, I hereby agree as follows:

  1. 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 or any other Birmingham Rage Room activities, 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 COVENANT NOT TO MAKE OR BRING ANY SUCH CLAIM AGAINST THE BIRMINGHAM RAGE ROOM OR ANY OTHER RELEASEE, AND FOREVER RELEASE AND DISCHARGE THEM FROM LIABILITY UNDER SUCH CLAIMS;
  2. TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from and against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by/awarded against the indemnified party arising out of or resulting from any claim of a third party resulting from, arising in connection with, or otherwise related to, my Participation;
  3. This 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;
  4. This Agreement and any rights, duties and obligations as between the parties to this Agreement shall be governed by and interpreted solely in accordance with the laws of the State of Alabama without regard to its conflict of laws provision;
  5. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Alabama without giving effect to any choice or conflict of law provision or rule (whether of the State of Alabama or any other jurisdiction). Any claim or cause of action involving the parties to this Agreement or arising regarding this Agreement shall be brought solely within the Birmingham Division of Jefferson County, Alabama or in the federal courts located in Jefferson County, Alabama, and I consent to the exclusive jurisdiction of such courts.


PHOTO/VIDEO RELEASE

I consent to and grant the Birmingham Rage Room the right to make, use, reproduce, publish, assign, and/or distribute photographs, video, and/or sound recordings of me taken or recorded in the course of Participation, in any materials it may create or authorize for advertising, promotional and/or marketing purposes.


MISCELLANEOUS

I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect; if any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction.

In entering into this Agreement I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of Participation, other than what is set forth in this Agreement; this Agreement constitutes the sole and entire agreement of the Birmingham Rage Room and myself with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter.

This Agreement is binding on and shall inure to the benefit of the Releasees and myself.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS FOR MYSELF, MY HEIRS, SUCCESSORS, AND ASSIGNS, INCLUDING THE RIGHT TO SUE THE COMPANY.


Today's Date: May 3, 2024 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle 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.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
I, as parent/guardian with legal responsibility for this Participant, have carefully read, understand and voluntarily agree to each of the provisions contained in the Agreement on behalf of myself and my Minor. I further acknowledge that each of the provisions in the Agreement shall be effective and binding upon me and each of the Releasing Parties. This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of Participation and his/her responsibilities for adhering to the rules and regulations. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s/ward’s involvement or Participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle 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.


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