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RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, INDEMNITY AND PUBLICITY RELEASE AGREEMENT
(Hereinafter, the “Release Agreement”)
PLEASE READ AND REVIEW THIS RELEASE AGREEMENT CAREFULLY.

BY SIGNING THIS RELEASE AGREEMENT, YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT.

The undersigned hereby releases Serpico Family Investments LLC dba Breakthrough Smash Room and its 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 “) as set forth in this Release Agreement. In this Release Agreement, the term “Activities” shall include any use or participation in the Smash Room facility, and any other area of the Releasees’ premise, and related equipment, and any other activities, events or services provided, arranged, organized, sponsored, or authorized by the Releasees in any way associated or connected with the Smash Room.

ASSUMPTION OF RISKS -- I am aware that the Activities involve unusual risks, dangers and hazards including, but not limited to: (i) accidents which may occur in the facility; (ii) slips and falls; (iii) malfunction of the equipment, safety gear, smashing tools, or other items used; (iv) injury and open wounds; (v) negligence on the part of other persons or failure to follow employee instructions; (vi) shock, stress or other injury to the body while participating in the Activities or the aggravation or worsening of any existing medical condition; and (vii) 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 ACTIVITIES AND THAT THE FORGOING LIST IS NOT INCLUSIVE OF ALL POSSIBLE INHERENT RISKS ASSOCIATED WITH THE ACTIVITIES. I have received full information regarding the Activities and have had the opportunity to ask any questions that I had regarding the same. I acknowledge that the Activities may result in injury, worsening of an existing medical condition, or death. Notwithstanding the forgoing, 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 the Activities may place unusual stresses on the body. The Activities 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 are not recommended to engage in the Activities. I have been advised to consult with my medical practitioner if I have any concern about my medical conditionor fitness to engage in the Activities.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT -- In consideration of the Releasees agreeing to my participation in the Activities, and permitting my use of the Activities’ equipment, room, and other facilities, 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, claim, suits, causes of action, demands, expenses, or injury including without limit, death that I may suffer, or that my next of kin may suffer, as a result of my participation in the Smash 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 THE ACTIVITIES;
  2. TO FULLY RELEASE AND INDEMNIFY THE RELEASEES from any and all liabilities, suits, claims, causes of action, demands, damages, losses or costs of any nature (including attorney’s fees) whatsoever arising out of, or in any way relating to, the Activities, including without limitation, for any property damage or personal injury to any third party resulting from my participation in the Activities, whether or not there are any allegations or charges of negligent acts or omissions on the part of any other parties, including the Releasees; 
  3. My participation in the Activities is purely voluntary, and I elect to participate despite the risks described herein and I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of the Activities, other than what is set forth in this Release Agreement;
  4. I am at least 18 years of age and legally competent to sign this Release Agreement. If I am under the age of 18, this Release Agreement must also be signed and filled out below by my parent or legal guardian;
  5. I have no medical or physical conditions which interfere with my ability to participate safely in the Activities;
  6. I have not consumed alcohol, I am not intoxicated, and I am not under the influence of liquor or drugs;
  7. 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;
  8. 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 state of Arizona and no other jurisdiction;
  9. Any litigation involving the parties to this Release Agreement shall be brought solely within the city of Phoenix and shall be within the exclusive jurisdiction of the Courts of Arizona.

I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT PRIOR TO SIGNING 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.

Today's Date: August 2, 2025

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
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.


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*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
PHOTO/VIDEO RELEASE
By checking this box, I consent to photographs and videos being taken of me during my participation in the Activities, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing, and other commercial and business purposes with no monies paid to me.
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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