Loading...

Selfie WRLD Indy Waiver


SELFIE WRLD RELEASE FORM

 

READ THIS DOCUMENT FULLY BEFORE SIGNING.  ITS EFFECT IS TO RELEASE SELFIE STATION LLC DBA SELFIE WRLD, ITS OWNERS, STAFF AND OTHERS WORKING IN ITS EMPLOY, FROM ANY LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE ACTIVITIES AT SELFIE WRLD AND ITS FRANCHISEES. AND WAIVES ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST SELFIE WRLD. IT ALSO GRANTS SELFIE WRLD AND ITS FRANCHISEES THE RIGHT TO USE OF YOUR LIKENESS IN PROMOTIONS, MARKETING AND ANY OTHER BUSINESS-RELATED ACTIVITIES.

 

MEDICAL RELEASE

 

I, the undersigned, my heirs, executors, and administrators, waive, release and forever discharge and agree to indemnify and hold harmless SELFIE WRLD, its owners, staff, and others working with this individual, from all rights, claims, demands or causes of action from damages, injury or loss to person or property which may be sustained or occur during participation in any activity while at SELFIE WRLD, whether or not damages, injury or loss due to the fault, negligence, or any other actions of SELFIE WRLD, its owner, staff or anyone working in its employ.

COVID 19 – I acknowledge and understand that participation includes possible exposure to and illness from infectious diseases including, but not limited to COVID-19. While particular rules and personal discipline may reduce the risk, the risk of serious illness and death does exist.  I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of Released Parties.  I hereby further agree to indemnify and hold harmless SELFIE WRLD, its owners, staff and employees from any loss, liability, damage or cost they may incur arising out of or related to illness or death of me or any persons I purchased a ticket for.


DAMAGE

I shall be solely responsible for any damage to Selfie WRLD’s property or props that occurs during the time I occupy the premises.  Should something break, I agree to pay reasonable repair costs to bring damaged items back to working condition or new, if necessary.   I also agree to pay for damage to the premises including spills, marks or stains on furniture, or fixtures. I agree to leave the premises in the same condition as it was when I arrived.   .  Selfie WRLD will not be responsible for any lost items. No food, drinks, alcohol nor smoking is allowed at Selfie WRLD besides bottled water/sodas, unless otherwise agreed upon.



CONSENT TO USE OF LIKENESS

 

I, the undersigned, do hereby certify that I am the individual undersigned.

 

I grant to SELFIE WRLD, the right to take and use my photographs and/or videos.

 

I authorize SELFIE WRLD its assigns and transferees to copyright, use and publish the same in print and/or electronically agree that SELFIE WRLD may use such photographs/videos of undersigned with or without their name for any lawful purpose.  This includes but is not limited to such purposes as publicity, illustration, advertising, social media, tagged photos/videos and web content without reservation or limitation.  I have read and understand with my consent and release. 

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.


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*

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!