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AXEIOM ENTERTAINMENT INC

ACCIDENT WAIVER

AND RELEASE OF LIABILITY

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. 

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems that preclude my participation in this activity. 

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. 

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: 

I Agree
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, 

THE FOLLOWING ENTITIES OR PERSONS: 

AXEIOM ENTERTAINMENT INC, or their owners, directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and property owners. 

I Agree
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in (A) paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. 

I acknowledge that AXEIOM ENTERTAINMENT INC, and their owners, directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. 

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants,

equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. 

I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this activity. 

I understand that while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. 

The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 

I Agree
I understand that all participants signing their own waiver must be at least 18 years of age. I further understand that any and all minors aged 12 to 17 may participate only under the waiver of a parent or guardian who must be present and participating in the activity. 

I Agree
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. 


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
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. Please take note that all minors who will be participating MUST be at least 12 years of age.




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 Additional Information:
At AXEIOM we strive to ensure we prepare to serve all of our customers in the most inclusive possible manner. Do any of the following selections pertain to individuals covered by this waiver?
Hearing Condition
Vision Condition
Wheelchair or other mobility device
Other mobility condition which may require special assistance
Prosthetic devices which may affect the participant's access to the facility or manner of throwing
Sensory condition or sensitivities that may require accommodation
Condition affecting learning or understanding
Allergies or sensitivities to environmental conditions which could require medical intervention if triggered
Medical condition which could require emergency intervention

Please elaborate on any of the selections you have made above:
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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