Loading...

 DANGER VALLEY LLC (DVLLC) DOES NOT IN ANY WAY CLAIM TO BE A MENTAL HELP OR A PLACE OF ANGER THERAPY. DVLLC IS A PLACE OF ENTERTAINMENT ONLY. STAFF/ BUILDING MANAGEMENT RESERVE THE RIGHT TO REFUSE ENTRY TO ANYONE AND TERMINATE ANY SESSIONS BY ANY LAWFUL MEANS, IF THEY BELIEVE THAT A/ THE PARTICIPANT(S) COULD BE/ CREATE A RISK OF HARM TO THEMSELVES, OTHER PARTICIPANTS OR TO THE BUSINESS.

I HEREBY RELEASE, ACQUIT, AND FOREVER DISCHARGE, WITHOUT QUALIFICATION OR LIMITATION the Releases from any and all claims I may now and/or in the future may have against the Releasers, and from any and all liability, for any personal injury, death and/or property damage, expense, and/or loss sustained by me as a result of my participation in the Activity due to any cause whatsoever, including but not limited to and without limitation, negligence, gross negligence, willful misconduct, including the failure to take reasonable steps to safeguard or protect me from the risk, dangers, and/or hazards of participating in the Activity, and/or breach of statutory or other duty, including duties arising from occupier's liability legislation.


THE RELEASOR ACKNOWLEDGES AND ACCEPTS that the Activity is inherently risky and dangerous, and there is the possibility of personal injury, death, property damage and/or loss resulting therefrom.


THE RELEASOR AGREES that he/she will be fully responsible for all costs and expenses that may be incurred in providing any special services to him/her, outside of regular services agreed to or provided by the releases in connection with the Activity, and without limiting the generality of the foregoing, agrees to be responsible for, and to pay for any and all costs relating to special travel, medical attention, or other special outlay for him/her personally, and to reimburse the releases for all costs of these services as may be incurred by them for his/her benefit or at his/her request.


IT IS AGREED AND UNDERSTOOD that if the Releaser commences such an action, or takes such proceedings, and the Releases are added to such proceeding in any manner whatsoever, whether justified in law or not, the Releaser will immediately discontinue the proceedings and/or claims, and the Releaser will be jointly and severally liable to the Releases for the legal costs incurred in any such proceeding, on a substantial indemnity basis. This Release of Liability, Waiver, and Assumption of Risk shall operate conclusively as an estoppel in the event of any claim, action, complaint or proceeding which might be brought in the future by the Releaser with respect to the matters covered by this Release of Liability, Waiver, and Assumption of Risk. This Release of Liability, Waiver, and Assumption of Risk may be pleaded in the event any such claim, action, complaint or proceeding is brought, as a complete defense and reply, and may be relied upon in any proceeding to dismiss the claim, action, complaint or proceeding on a summary basis and no objection will be raised by the Releaser in any subsequent action that the other parties in the subsequent action were not privy to formation of this Release.


This agreement specifically contains an indemnity agreement whereby I agree to be responsible for all attorney’s fees and defense costs incurred by DANGER VALLEY LLC (dba Valley Smash Rage Room) in connection with or in the defense of a lawsuits, claim, or action brought by myself, my child/ ward, or any other party related in any way to me or my child(ren)/ward(s) use of the DANGER VALLEY LLC (Valley Smash Rage Room) facility. I am voluntarily giving up mine and/or my child(ren)/ward’s right to bring a lawsuit or claim against the mentioned releases. I further understand and accept the above risks related to these activities. 12) This “waiver and release of liability ” form will be used in defense by the organizers of the activity if needed. I WAIVE, RELEASE, AND DISCHARGE from any and all liability.


PHOTOGRAPHS, VIDEOS AND RECORDINGS I hereby grant Danger Valley LLC/ Valley Smash Rage Room, its managers, employees, and owners (collectively) non-revocable permission to capture my image and likeness in photographs, videotapes, recordings, or any other media (collectively “images”). I acknowledge that Danger Valley LLC/ Valley Smash Rage Room will own such images and further grant Danger Valley LLC/ Valley Smash Rage Room permission to copyright, display, publish, distribute, use, modify, print and reprint such images in any manner whatsoever related to Danger Valley LLC/ Valley Smash Rage Room business, including without limitation, publications, advertisements, brochures, website images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the image by Danger Valley LLC/ Valley Smash Rage Room prior to its use. I forever release and hold Danger Valley LLC/ Valley Smash Rage Room harmless from any and all liability arising out of the use of the images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the images, including without limitation, claims for invasion of privacy rights or publicity. I accept Danger Valley LLC/ Valley Smash Rage Room taking pictures or videos of me and publishing on any media source for advertising.


By signing below I acknowledge and understand failure to obey or follow any of the regulations stated above, can lead to legal action and/ or prosecution. I hereby voluntarily take action for myself and if applicable allow the minor child(ren) identified below under my supervision to use Danger Valley LLC/ Valley Smash Rage Room facility.

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*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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*

Middle 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. 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!