Participant’s
Name ___________________________________________________
Parent’s/Guardian’s
Name ____________________________________________
1.
The participant wishes to participate in:
___ Laser Tag ___ Dodgeball ___ Bouncey Fun Express Train Station ___Junior Sports
2.
As a participant, I:
A. Acknowledge
that participation in the activities selected above involves physical activity
and/or the use of equipment apparatus and facilities that could result in injury to the
participant. The participant assumes full responsibility for any injuries or
damages which may occur to or be caused by the participant in, on, or about
Lazerland of LI’s premises or as a result of participation in any of the
activities at Lazerland of LI, from whatever cause, including, without
limitation, the negligence of Lazerland of LI, its owners, employees, agents,
customers, invitees or visitors, and releases, discharges, and agrees to
indemnify and hold harmless Lazerland of LI, its owners, employees, and agents
from and against all loss, liability and expense present or future, whether or
not known or anticipated, arising out of or resulting from, directly or
indirectly, the participant’s presence at Lazerland of LI’s premises, use or
intended use of or participation in any of the games featured, offered or
conducted at Lazerland of LI, use or intended use of Lazerland of LI’s
premises, facilities, and/or use or intended use or any equipment or apparatus
related thereto. The undersigned has read and understands the foregoing waiver.
The undersigned acknowledges that if he/she is under 21 years of age, he/she
has discussed the terms and conditions of this waiver with his/her parents or
legal guardians and has each such parent’s or legal guardian’s consent to
his/her signing this waiver and to the provisions, agreements, terms and
conditions of this waiver.
B. Agree
to play the activities according to the rules and instructions given to me by
any members of Lazerland of LI’s staff. I acknowledge that Lazerland of LI
accepts no responsibility for any act or anything done by me which is not in
accordance with the rules and instructions of Lazerland of LI.
C. Accept full
responsibility for any damage to the Lazerland of LI premises, facilities,
and/or equipment caused by me.
D. Agree to inform a member of the Lazerland of LI staff of any medical condition or treatment that I have, prior to participating in any activity at Lazerland of LI.