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Waiver
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rmharp authored Sep 12, 2023
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><head><meta http-equiv="Content-Type" content="text/html; charset=utf-8"/><title>CT_Wavier_23-24</title><style type="text/css"> * {margin:0; padding:0; text-indent:0; }
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</style></head><body><p style="text-indent: 0pt;text-align: left;"><br/></p><p style="text-indent: 0pt;text-align: left;"><span><img width="86" height="86" alt="image" src="CT_Wavier_23-24_files/Image_001.png"/></span></p><p class="s1" style="padding-top: 4pt;padding-left: 81pt;text-indent: 0pt;text-align: left;">Chapel Thrill Escapes Participant Accident, Risk, and Release of Liability Wavier</p><p style="padding-top: 7pt;padding-left: 81pt;text-indent: 0pt;text-align: left;"><span class="s2" style=" background-color: #000;"> </span><span class="p" style=" background-color: #000;">Please read completely and fill out accurately. Return to staff member when complete. </span></p><p style="text-indent: 0pt;text-align: left;"><br/></p><table style="border-collapse:collapse;margin-left:5.4843pt" cellspacing="0"><tr style="height:26pt"><td style="width:184pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">Parent/Guardian/Participant (if over 18): First Name</p></td><td style="width:198pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="3"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">Last Name</p></td><td style="width:122pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">Date of Birth (DOB)</p></td></tr><tr style="height:26pt"><td style="width:198pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Street Address</p></td><td style="width:40pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Apt. #</p></td><td style="width:122pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">City</p></td><td style="width:76pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">State</p></td><td style="width:68pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">ZIP</p></td></tr><tr style="height:26pt"><td style="width:126pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:3pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Cell Phone Number</p></td><td style="width:207pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:3pt;border-right-style:solid;border-right-width:1pt" colspan="2"><p class="s4" style="padding-left: 5pt;text-indent: 3pt;text-align: left;"><span><img width="11" height="11" alt="image" src="CT_Wavier_23-24_files/Image_002.png"/></span> <span class="s3">Mark box if you would like to receive free promotions, offers, and marketing materials via email or text message.</span></p></td><td style="width:171pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:3pt;border-right-style:solid;border-right-width:1pt" colspan="2"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Email Address</p></td></tr><tr style="height:381pt"><td style="width:504pt;border-top-style:solid;border-top-width:3pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:2pt;border-right-style:solid;border-right-width:1pt" colspan="5"><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">In consideration of my participation in the services of Chapel Thrill Escapes, 501(c)-3, their agents, owners, officers, affiliates, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “CT”), I hereby agree to release, indemnify, and discharge CT, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative, and estate as follows:</p><p style="text-indent: 0pt;text-align: left;"><br/></p><ol id="l1"><li data-list-text="1."><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">I acknowledge and assume that my participation in a CT escape room, and/or related activities, entails known and unknown risks that could result in physical and/or emotional injury, paralysis, permanent disability, death, and/or damage and theft to myself, to property, and/or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I expressly agree and promise to assume all the known and unknown risks existing in CT activities; <b>Known risks include, among other things: </b>use of simple tools, mental stress and anxiety, falling objects, moving or lifting objects, confinement in a reasonably small space with several persons, close contact with other participants, exposure to sharp objects, exposure to hazardous chemicals, slippery surfaces, exposure to sudden flashing of light, theft or damage to personal property, failure to escape the room in the allotted time.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="2."><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">I acknowledge that I have inspected the facilities, equipment, and areas to be used by CT and I’m voluntarily participating despite the risks, 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.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="3."><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">I acknowledge that, at the time of participation in any CT activities, I have no physical and/or mental illness that preclude(s) my participation in a safe manner for myself or others. I am not under the influence of drugs or alcohol that impair my ability to maintain my safety awareness or endanger others.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="4."><p class="s5" style="padding-left: 13pt;text-indent: -7pt;text-align: justify;">I agree to pay for all damages to the facilities of CT caused by my and/or my family’s negligent, reckless, or willful actions.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="5."><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">Non-Disclosure Agreement: I understand that any information regarding solving a room I obtain through participating in CT activities must be kept confidential. I agree that I will not disclose any information that assists in solving CT escape rooms to any person or entity, in-person or through any other means of communication. Accordingly, I agree not to capture any photographs, videos, and/or audio recordings of my participation in a CT game room.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="6."><p class="s5" style="padding-left: 13pt;text-indent: -7pt;text-align: justify;">I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="7."><p class="s5" style="padding-left: 13pt;text-indent: -7pt;text-align: justify;">I agree that any claim or action brought forth arising from my participation in CT activities shall be subject to and resolved under North Carolina law.</p><p style="text-indent: 0pt;text-align: left;"><br/></p></li><li data-list-text="8."><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless CT from any and all claims, demands, and/or causes of action, which partly or wholly allege damages or negligence arising from any known risks and/or unknown risks in CT activities and/or my use of CT materials or facilities, and further <b>including any such claims which allege negligent acts and/or omissions of CT </b>to the fullest extent permitted by law<b>.</b></p></li></ol><p style="text-indent: 0pt;text-align: left;"><br/></p><p class="s6" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">By signing this agreement, 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 against CT on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have without pressure read and understood it, and I agree to be bound by its terms.</p><p style="text-indent: 0pt;text-align: left;"><br/></p><p class="s5" style="padding-left: 5pt;padding-right: 4pt;text-indent: 0pt;text-align: justify;">I further grant CT the right to photograph, videotape, and/or record me and/or my child/ward and to use my or my child’s/wards’ name, face, likeness, voice, and appearance in connection with exhibitions, publicity, advertisements and promotional materials without reservation or limitation.</p><p style="text-indent: 0pt;text-align: left;"><br/></p><p class="s7" style="padding-left: 5pt;text-indent: 0pt;line-height: 11pt;text-align: justify;">Participant Signature (if 18 or older): <span class="s8">&nbsp;</span><span class="s4"> </span>Date: <span class="s8">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p></td></tr><tr style="height:21pt"><td style="width:504pt;border-top-style:solid;border-top-width:2pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="5"><p class="s9" style="padding-left: 5pt;padding-right: 34pt;text-indent: 29pt;line-height: 10pt;text-align: left;">PARENT’S OR LEGAL GAURDIAN’S ADDITIONAL INDEMNIFICATION <span class="s3">(Must be completed for participants under the age of 18) In consideration of (print up to three minor’s names/birthdates below of SAME parent or legal guardian):</span></p></td></tr><tr style="height:25pt"><td style="width:198pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">Participant 1: First Name</p></td><td style="width:189pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="3"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">Last Name</p></td><td style="width:117pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;line-height: 9pt;text-align: left;">DOB</p></td></tr><tr style="height:25pt"><td style="width:198pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Participant 2: First Name</p></td><td style="width:189pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="3"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Last Name</p></td><td style="width:117pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">DOB</p></td></tr><tr style="height:25pt"><td style="width:198pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Participant 3: First Name</p></td><td style="width:189pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="3"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Last Name</p></td><td style="width:117pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt"><p class="s3" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">DOB</p></td></tr><tr style="height:41pt"><td style="width:504pt;border-top-style:solid;border-top-width:1pt;border-left-style:solid;border-left-width:1pt;border-bottom-style:solid;border-bottom-width:1pt;border-right-style:solid;border-right-width:1pt" colspan="5"><p class="s5" style="padding-left: 5pt;padding-right: 2pt;text-indent: 0pt;text-align: left;">(“Minor”) being permitted by CT to participate in its activities, I further agree to indemnify and hold harmless CT from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor. I further certify that I am the parent or legal guardian of the minor on this agreement.</p><p class="s9" style="padding-left: 5pt;text-indent: 0pt;text-align: left;">Parent or Guardian’s Signature: <span class="s10">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span class="s11"> </span>Print Name: <span class="s10">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span class="s11"> </span>Date: <span class="s10">&nbsp;&nbsp;&nbsp;&nbsp; </span></p></td></tr></table><p style="text-indent: 0pt;text-align: left;"><br/></p><p style="text-indent: 0pt;text-align: left;"><span><img width="49" height="23" alt="image" src="CT_Wavier_23-24_files/Image_003.png"/></span></p><h1 style="padding-top: 4pt;text-indent: 0pt;text-align: right;">Waiver accepted by <span class="s12">(Initials of CT)</span></h1></body></html>

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