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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES

ASSOCIATED WITH THIS ESCAPE THE ROOM 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 understand this activity has potential risks including but not limited to:

1) Use of simple tools;

2) Potentially moving or lifting objects of not more than twenty pounds;

3) Mental stress and anxiety;

4) Being in a reasonably small space with up to fifteen persons;

5) Possibility of failure to escape the room in the allotted time.

I have no physical or mental illness that precludes my participation in a safe manner for myself or others. I

am not under the influence of drugs or alcohol which impairs my ability to maintain my safety awareness

or endangers others.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of

the activity in which I may participate, and that it will govern my actions and responsibilities at said

activity. I agree that all staff or authorized agents may, in their sole discretion, determine it is unsafe for

myself or others for my participation to continue, remove me from the premises by any lawful means.

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:

(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, THE FOLLOWING ENTITIES OR PERSONS: The directors, officers, employees, volunteers,

representatives, and agents of any and all entities authorizing this activity;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons

mentioned in this 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 the directors, officers, employees, volunteers, representatives, and agents of any

authorizing entity 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 hereby consent to receive medical treatment which may be deemed advisable in the event of injury,

accident, and/or illness during this activity.

I understand 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 this authorizing entity decides, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and

waiver to the maximum extent permissible under applicable law.

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


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