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PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Central Oregon Bungee Adventures their agents, owners, officers, volunteers, employees, and all other

persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "COBA "), I hereby agree to release,

indemnify, and discharge COBA on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and

estate as follows:

1.I acknowledge that my participation in Bungee Jumping activities entails known and unanticipated risks that could result in physical

or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be

eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: Risks include negligence by other participants or myself; slips and falls; falls from significant

heights; accidents during harnessing, strapping in, and dismounting; rope entanglement; impact with the ground or other objects; and being

struck by equipment. Additional risks include those related to my physical condition and possible contact with animals or insects. Injuries

may include bruises, sprains, burns, musculoskeletal injuries (including to the head, neck, and back), and heart-related complications. More

serious risks include internal injuries, loss of fingers or other body parts, equipment failure, and exposure to transmissible pathogens or

diseases. Physical exertion may also aggravate pre-existing medical conditions or contribute to injury.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely

voluntary, and I elect to participate in spite of the risks. Additionally, I agree to wear a properly fitted and secured certified helmet

while participating in this activity.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless COBA from 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 COBA 's equipment or facilities,

including any such claims which allege negligent acts or omissions ofCOBA.

4. Should COBA or anyone acting on their behalf be required to incur attorney fees and costs to enforce this agreement, I agree to

indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear

the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I

may have.

6. In the event that I file a lawsuit against COBA I agree to do so solely in the state of Oregon and I further agree that the substantive law

of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement

is found to be void or unenforceable, the remaining document shall remain in full force and effect.

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 my right to maintain a lawsuit againstCOBAon the basis of any claim from which

I have released them herein. I also agree that this document is valid for subsequent visits and participation at COBA.

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.

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







Parent or Guardian's Email Address
Email
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Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
How Did You Hear About Us
Select*
If other please specify...
Jumpers Weight (Best Estimate)
Click to customize text box label

PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

(Must be completed for participants under the age of 18)  

In consideration of the minors listed above: being permitted by COBA to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless COBA from any and all claims which are brought by, or on behalf of minor(s), and which are in any way connected with such use or participation by minor(s). Minor(s) DOB(s) 

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*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Video Release

By signing this release form, I authorize Central Oregon Bungee Adventures, to use the following personal information:

(1) My picture - including photographic, motion picture, and electronic (video) images.

(2) My voice - including sound and video recordings.

I hereby grant to Central Oregon Bungee Adventures, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing. 

I further grant Central Oregon Bungee Adventures all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Central Oregon Bungee Adventures the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Central Oregon Bungee Adventures use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied.

I acknowledge that I have read the foregoing and I fully understand the contents.

IN WITNESS WHEREOF, I have executed this release on:

[date]







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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