ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES at Academy Arial Arts AAA PCS, 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 six persons; 5) Possibility of failure to escape the room in the
allotted time. 6) Possibility of falling objects.
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. The undersigned further acknowledges that he/she has inspected the facilities, equipment,
and areas to be used for Academy Arial Arts AAA PCS and is voluntarily participating despite the risk of falls, contact and/
or crashes with other participants, defective equipment, the condition of the room and any hazards that may be posed
by spectators or volunteers. 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 agree that Academy Arial Arts AAA PCS or any of its assign’s has the right to any photos or any video/sound footage of me
during the Academy Arial Arts AAA PCS event. These photos, video footage and sound materials may be used for any
I fully understand that there are no refunds under any conditions once I purchase my entrance fee.
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.
WHEN REGISTERING ONLINE, MY ONLINE SIGNATURE SHALL SUBSTITUTE FOR AND HAVE THE SAME
LEGAL EFFECT AS IF I HAD SIGNED A WAIVER AND RELEASE AGREEMENT.
________________________________ __________ _______________________________
Participant’s Signature Date Participant’s Name Age
Parent/Guardian Signature Date (If under 18 years old, Parent or Guardian must also sign.)