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WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNIFICATION

AND HOLD HARMLESS AGREEMENT FOR LYNCH IMPORTS LLC

 Demo

May 4, 2024


The Undersigned and Individuals listed below, together with their heirs, assigns, and successors ("Undersigned"), hereby agree to waive any and all liability resulting from any occurrence giving rise to a cause of action, including but not limited to accidents, any negligence, intentional acts, any misuse, any type of participation either directly or indirectly with pyrotechnics or pyrotechnic related activities or any other activities, with respect to the owner of the land at 11628 IN-46 Sunman, IN, on which pyrotechnics are to be used, demonstrated, manufactured, sold, bought, displayed or destroyed, Lynch Imports, LLC and JMKL, LLC and their members, officers, staff, agents, employees, guests, successors or licensees, any operator, any permit holder, or any instructor(s) of or for pyrotechnics use, displays, demonstrations, sales or purchases of pyrotechnics or pyrotechnics related materials or any other pyrotechnic related event activity ("Hosts").  Undersigned hereby agree to waive any and all liability of or for claims against Hosts resulting from any occurrence giving rise to a cause of action, including but not limited to: accidents, intentional or negligent acts, equipment or product malfunction or failure, negligence or misuse of vehicles, property, or possessions, pyrotechnic related activities, behavior or acts by pets, family members, children, and from acts by guests invited by anyone with or without permission of any of the listed parties. The Undersigned further agree to abide by all safety rules and conduct guidelines of the Hosts and other listed parties, pyrotechnics and/or explosive laws and regulations of the BATFE, NFPA and State of Indiana or regulations of any other authority with jurisdiction.  It is expressly understood that any violation, deviation, failure to obey or follow said rules or guidelines or any local, state, or federal laws or regulations by the Undersigned is cause for the immediate suspension of event attendance or privileges and immediate expulsion from the site, without any right to return, upon which said activities are being held.  The Undersigned state they are aware of the numerous federal, state, local laws, regulations and private rules and guidelines that control items that might be sold, transferred, or purchased during the event and specifically states that they will comply with the applicable laws, regulation, rules and guidelines.  They also agree to abide by any and all laws, regulations, rules or guidelines that are enforced by federal, state, local or private Authorities Having Jurisdiction (AHJ) with jurisdiction over the items purchased by them.  The Undersigned understand that failure to abide by the applicable laws, regulations, rules or guidelines could cause them to incur costs or to be fined and/or incarcerated by the appropriate AHJ.  The Undersigned specifically state that they do not intend to use any materials or information purchased or acquired at the event for manufacture of any banned hazardous materials as defined by 15 U.S.C.  1261(q)(1) or engage in any other activity prohibited by law. The Undersigned expressly state they are the parent or guardian for any minor listed below and agree that all terms of this Waiver of Liability, Assumption of Risk, Indemnification and Hold Harmless Agreement applies to said minors.  The Undersigned understand that pyrotechnic material is and will be used at the event and that a risk is associated with the use of pyrotechnic material even if the pyrotechnic material is handled in an appropriate manner and all safety rules and guidelines are followed.  The Undersigned understands the risk associated with pyrotechnic material and voluntarily assumes said risk associated with the use of pyrotechnic materials at the event.  The Undersigned agree to reimburse and indemnify the Hosts for any and all costs and expenses associated with the Undersigneds activities or any violation of law, statute, regulation, private rule or private guideline.  The costs and expenses to be reimbursed may include, but not be limited to, attorney fees, court costs, investigation costs, travel costs, equipment replacement, labor costs, and supply replacement.  The Undersigned agree to completely and immediately indemnify and hold harmless the Hosts from any and all claims made by the Undersigned or any Federal, State or Local Authority or other AHJ, as a result of any and all acts, including but not limited to the selling, distribution, transfer, manufacture or display relating to any pyrotechnic material purchased or used by the Undersigned at or in relation to the event.

I hereby state that I have read and understand the foregoing Waiver of Liability, Assumption of Risk, Indemnification and Hold Harmless Agreement and agree to abide by all its terms.

Date: April 28, 2024

First Attendants/Participants Name

First Name*

Last Name*

Phone*
First Attendants/Participants Age Acknowledgment*
First Attendants/Participants Date of Birth*
I certify that I am 18 years of age or older
First Attendants/Participants Signature*
Second Attendants/Participants Name

First Name*

Last Name*
Second Attendants/Participants Date of Birth*
Third Attendants/Participants Name

First Name*

Last Name*
Third Attendants/Participants Date of Birth*
Fourth Attendants/Participants Name

First Name*

Last Name*
Fourth Attendants/Participants Date of Birth*
Fifth Attendants/Participants Name

First Name*

Last Name*
Fifth Attendants/Participants Date of Birth*
Sixth Attendants/Participants Name

First Name*

Last Name*
Sixth Attendants/Participants Date of Birth*
Seventh Attendants/Participants Name

First Name*

Last Name*
Seventh Attendants/Participants Date of Birth*
Eighth Attendants/Participants Name

First Name*

Last Name*
Eighth Attendants/Participants Date of Birth*
Ninth Attendants/Participants Name

First Name*

Last Name*
Ninth Attendants/Participants Date of Birth*
Tenth Attendants/Participants Name

First Name*

Last Name*
Tenth Attendants/Participants Date of Birth*
Attendants/Participants 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 Email Address

Email
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A signed copy of this waiver will be sent to the email address you provide.
Additional Information
Do you have a current Federal Explosives License?*
No
Yes
Do you operate a consumer firework store/tent?*
No
Yes
Have you purchased from us before?*
No
Yes
Which best describes you?*
Current customer
Potential customer
Helper/employee of a customer or potential customer
Friend, spouse, or relative of a customer

Please name one product that we don't carry that you would buy from us.

Is there anything else you would like to share with us today?
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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