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AGREEMENT AND RELEASE OF LIABILITY

I hereby represent and warrant that the information provided above is true and correct in all material respects and may be fully relied upon by the Refinery. I agree that any material misrepresentation on this page shall be a violation of my Non-Member Agreement or Membership with the Refinery. I hereby make an application for non-member status or membership.

RELEASE OF LIABILITY(IMPORTANT, Please read very carefully before signing):IN CONSIDERATION

of the Refinery granting use of the facility, I hereby agree that neither the Refinery or nor any of its directors, officers, employees, or agents shall be liable for any damages from personal injury or property damage sustained by (i) me, (ii) any other person covered by my membership, or (iii) any guests utilizing the facility pursuant to my membership, in each such case in, on, or about the premises or as a result of me or any of such other persons using the facilities or equipment. By my execution of this agreement, I understand and agree that I assume full responsibility for any such injuries or damages to me or to such other persons. I further understand and agree that I shall be fully responsible for all personal belongings brought into the facility by me or such other persons and that the Refinery shall not be liable for any loss or theft of or damage to such personal property.

INDEMNIFICATION (IMPORTANT, please read very carefully before signing):

IN FURTHER CONSIDERATION OF THE REFINERY GRANTING ME TEMPORARY MEMBERSHIP OR USE, AS WELL AS OTHER GOOD AND VALUABLE CONSIDERATION, THE SUFFICIENCY OF WHICH IS HEREBY ACKNOWLEDGED BY ME, I HEREBY AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS REFINERY AND ITS DIRECTORS, OFFICERS, EMPLOYEES, AND AGENTS FROM AND AGAINST ANY AND ALL CLAIMS, LOSSES, DAMAGES, CAUSES OF ACTION, SUITS, AND LIABILITY OF ANY KIND OR NATURE WHATSOEVER (INCLUDING, BUT NOT LIMITED TO, ALL EXPENSES OF LITIGATION, COURT OR OTHER PROCEEDING COSTS, AND ATTORNEYS' FEES), FOR INJURY TO ME OR TO ANY OTHER PERSON COVERED BY MY MEMBERSHIP, WHETHER A FAMILY MEMBER OR GUEST (INCLUDING, BUT NOT LIMITED TO, DEATH), OR ANY DAMAGE SUSTAINED BY ME OR BY SUCH ANY OTHER PERSON ARISING, DIRECTLY OR INDIRECTLY, FROM MY USE OR SUCH OTHER PERSON'S USE OF THE FACILITIES (INCLUDING, BUT NOT LIMITED TO, ITS PARKING LOTS), PROGRAMS, AND EQUIPMENT, REGARDLESS OF WHETHER SUCH INJURY, DEATH, OR DAMAGE IS CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE REFINERY (OR THAT OF ANY OF ITS DIRECTORS, OFFICERS, EMPLOYEES, OR AGENTS), SOLELY AND UNILATERALLY OR JOINTLY AND CONCURRENTLY WITH ANY OTHER PERSON OR ENTITY. I covenant and agree to be bound by and to comply fully with the rules, regulations, and policies of the Refinery and to cause and assure that every person covered by my membership or utilizing my membership as a guest also fully complies with such.

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
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.


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*
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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