Loading...


Participant Agreement, Release, and Acknowledgement of Risk

Agreement Effective:        01/01/2023 - 12/31/2023






In consideration of the services and facilities to be provided by AirlineAmusement Park, Inc (dba: Palmer’s Family Fun), their agents, owners, officers, volunteers, participants, employees, and all other persons of entities acting in any capacity on their behalf (herein after collectively referred to as “Palmer’s Family Fun”), the undersigned party hereby agree to release and discharge Palmer’s Family Fun, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate, as follows:

1. I acknowledge that my participation in outdoor family fun activities such as go-karting, archery tag, laser tag, jumping pillow, driving range, batting cage, and mini golf entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties, but that such risks simply cannot be eliminated without jeopardizing essential qualities of the activity. Furthermore, Palmer’s Family Fun employees/attendants/facilitators have difficult jobs to perform. They seek safety as their utmost concern, including thorough equipment inspections, comprehensive safety talks, constant supervision and continuous training, but they are not infallible. They might be unaware of a participant’s mental and physical abilities. They might misjudge the weather, the elements, or the terrain. They may be unable to give adequate warnings or instruction because of unpredictable situations, or the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all reasonable risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Palmer’s Family Fun from and against any and all claims, demands or causes of action, which are in any way connected with my participation in this activity or my use of Palmer’s Family Fun’s equipment or facilities, including any such claims which allege negligent acts or omissions of Palmer’s Family Fun.

4. I certify that I have adequate insurance to cover any injury or damage I may suffer while participating or else I agree to bear the costs of such injury or damage to myself. I further certify that I have no medical or physical conditions that could interfere with my safety in this activity, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such conditions.

5. The parties agree to submit to binding arbitration any dispute regarding the terms or interpretation of this agreement.

6. The laws of the state of Iowa will govern the resolution of any conflict regarding this agreement without regard to any conflict of laws principles. Venue of any action hereunder shall be in the Black Hawk County District Court. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. I understand that photos and video taken during the program may be used for promotion and advertising. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived any right to maintain a lawsuit against Palmer’s Family Fun on the basis of any claim from which I have released them from herein.


Parent’s or Guardian’s

Additional Indemnification (must be completed for participants under the age of 18) In consideration of ________________________________,___________________________

___________________________,_____________________________(print name of Minor(s)

(“Minor”) being permitted by Palmer’s Family Fun to participate in those activities and to use its equipment and facilities, the undersigned custodial parent or legal guardian of the Minor hereby consents to the Minor’s participation in the activities and agrees to the terms and conditions and to be fully bound by the foregoing Agreement with respect to any and all claims which are brought by, or on behalf of, Minor. The undersigned further warrants and represents to Palmer’s Family Fun that he or she is a custodial parent or legal guardian of the Minor and has full capacity to sign this Agreement.



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

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 for the entire year of 2023, 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 for the entire year of 2023, 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!