Immersion escape rooms - liability waiver

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.

6) Use of step ladders and or crawling and moving through small spaces

7) Possible exposure to flashing lights and lasers. Please notify staff if you are at risk for epileptic seizures.

COVID-19: An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are especially vulnerable.

By visiting IMMersion escape rooms I voluntarily assume all risks related to exposure to COVID-19.

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.

Name of Participant

First Name

Last Name

Is the Participant Over The Age Of 18?

Yes

Participant's Date Of Birth

YYYY

Name Of Parent / Guardian (if participant is under the age of 18)

Enter "NA" For First Name and Last Name If Participant is over the age of 18.

First Name

Last Name

Participant's E-mail Address (or parent / guardian e-mail if participant is under the age of 18)

I Certify That:

I have not experienced a fever or other COVID-19 related symptoms within the past 14 days.

I Certify That:

I have not come into contact with anyone who has presented symptoms of COVID-19 within the past 14 days.

I Certify That:

I will notify Immersion Escape Rooms and reschedule my experience if I develop any COVID-19 related symptoms prior to my scheduled event.

I Understand That:

If not fully vaccinated for COVID-19, I am required to wear a mask at all times while at Immersion Escape Rooms and will follow this requirement.

Electronic Signature Consent

By checking below, 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.

I agree with the electronic signature consent.

Immersion escape rooms - liability waiver

Immersion Escape Rooms

creating original escape rooms in charlottesville since 2016.

© Copyright 2019 - Immersion Interactive, Inc.