2019 After Prom Information and Waiver Form
AGREEMENT, WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in any activities involving the use of a Bubble Ball, Knocker Ball, Zorb or other similar type of inflated sphere that surrounds portions of my upper body, whether as part of an organized league, game, match, practice or scrimmage, or otherwise related to any recreational use whatsoever (individually and collectively, an “Activity”) at the premises of Kingpin Properties, LLC, a Nebraska limited liability company, d/b/a The Mark (“Owner”), the undersigned, for himself/herself, and on behalf of all personal representatives, executors, heirs, successors, assigns, parents, guardians and spouses hereby agrees as follows:
- I acknowledge and fully understand that engaging in an Activity involves a significant and inherent risk of loss, damage or injury, including, but not limited to, physical or emotional injury, paralysis, death, or damage to myself, to property or to third parties, as well as potentially severe social and economic losses. The risks include, among other things: slips and falls; burns; collision with fixed objects or people; colliding with others; strains, sprains, broken bones and head injuries; cuts, abrasions, and bruises; heat exhaustion, heat stroke, and cardiac related events or illness; musculoskeletal injuries including head, neck, and back injuries; equipment failure or operator error; the negligence of other participants, or other persons who may be present; my own physical condition, and the physical exertion associated with the Activity. I understand that any of the foregoing might result not only from my own actions, inactions or negligence, but the actions, inactions or negligence of others or the conditions of the premises. Further, I understand that there may be other risks not known to me or not reasonably foreseeable at this time, and that medical insurance is not provided by Owner.
- I knowingly elect to fully accept and assume all of the foregoing risks associated with any Activity, and state that my participation in any Activity, whenever done, is voluntary and at all times subject to the terms of this Waiver and Release of Liability. I certify that I either have adequate medical and liability insurance to cover any loss, damage or injury that I may cause or that I may suffer in connection with any Activity or, if I have no such insurance or to the extent such insurance is inadequate, I am personally liable for all loss, damage or injury that I may cause or suffer.
- I hereby fully release, waive, discharge, indemnify, hold harmless and covenant not to sue Owner, and its respective operators, supervisors, managers, members, shareholders, officers, directors, employees, agents, subcontractors, independent contractors, successors and assigns, in addition to their agents, attorneys and other legal representatives, associations, sponsors, advertisers, and any lessees of any portion of the premises used to conduct any Activities, all of which are herein referred to as “Releasees,” from any and all liability to the undersigned, his/her heirs, next of kin, personal representatives, executors, successors, assigns, parents, guardians, third parties and spouses for and against any and all claims, demands, rights, causes of action, losses or damages of whatsoever nature, which the undersigned may now have or later may have, on account of any loss, damage or injury, including, but not limited to, permanent disability, death or property damage, and including any loss, damage or injury of the nature described in Section 1 above, arising in connection with the undersigned’s participation in any Activity or presence at the premises either before or following any Activity, even though any of the foregoing may be caused or alleged to be caused in whole or in part by the negligence, intentional acts, omissions or breach of contract by any or all of the Releasees or any third parties.
- I hereby certify that I am healthy and that I have no medical, physical, mental or emotional conditions that could interfere with or impair my ability to participate in any Activity. I am solely responsible for monitoring my health conditions and for making the decision whether or not to participate in any Activity at any time. I agree not to participate in any Activity while under the influence of any alcohol, drugs or any other substance that could impair my health, balance or judgment.
- I acknowledge and agree that in case any one or more of the provisions contained herein shall, for any reason, be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision of this Agreement, Waiver and Release of Liability, but this Agreement, Waiver and Release of Liability shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein. Further, I acknowledge and agree that this Agreement, Waiver and Release of Liability shall be construed and governed in accordance with the laws of the State of Nebraska, and shall be construed broadly to provide a waiver and release to the maximum extent permissible under Nebraska law.
BY SIGNING THIS AGREEMENT, WAIVER AND RELEASE, THE UNDERSIGNED AFFIRMS THAT:
- I AM NINETEEN (19) YEARS OF AGE OR OLDER (OR IF I AM UNDER THE AGE OF 19, THIS IS ALSO SIGNED BY MY PARENT OR LEGAL GUARDIAN);
- I HAVE BEEN PROVIDED THIS DOCUMENT AND HAVE READ IT;
- I UNDERSTAND AND AGREE TO ABIDE BY ITS CONTENTS AND TERMS;
- I HAVE NOT RELIED ON ANY REPRESENTATIONS OF ANY RELEASEES IN CHOOSING TO EXECUTE THIS DOCUMENT; AND
- I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.
Participant’s Signature: _____________________________________ Date: ___________________________
Participant’s Name (Print Legibly): ___________________________________
Participant’s Address (Print Legibly): ___________________________________________________________
IF PARTICIPANT IS UNDER AGE 19, PARENT OR LEGAL GUARDIAN MUST SIGN BELOW
CONSENT OF PARENT OR LEGAL GUARDIAN
I, ____________________________________ [print name legibly], represent that I am the parent or legal guardian of ____________________________________ [print minor’s name legibly], who is as of the date of execution of this Consent under the age of 19, and I hereby consent to his/her participation in each and every type of Activity (as defined in this Agreement, Waiver and Release of Liability) and/or use or presence upon the premises of Owner. I acknowledge that I am familiar with and agree on behalf of myself and on behalf of the above-named minor to all of the above terms and conditions of this Agreement, Waiver and Release of Liability. By signing this Agreement, Release and Waiver of Liability, I represent that I have legal authority over and custody of the above-named minor and am legally entitled to execute this Consent.
I HAVE FULLY READ THIS DOCUMENT, UNDERSTAND ITS TERMS, AND ACKNOWLEDGE THAT BY SIGNING I AM GIVING UP SUBSTANTIAL RIGHTS AND REMEDIES, INCLUDING SUBSTANTIAL RIGHTS AND REMEDIES HELD BY OR EXERCISABLE ON BEHALF OF THE MINOR. I ACKNOWLEDGE THAT I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY, AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE AND WAIVER OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I FURTHER AGREE THAT IF ANY PART HEREIN IS HELD INVALID, THE REMAINING PARTS OF THIS AGREEMENT WILL CONTINUE IN FULL FORCE AND EFFECT AS INTENDED.
Parent/Legal Guardian Signature: _____________________________________ Date: ____________________