Form must be signed and handed to a staff member prior to play.

COMPLETE THE FOLLOWING SECTION (PLEASE PRINT)

PLAYER’S FULL NAME: ____________________________________      

PARENT’S FULL NAME: ____________________________________

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin hereby release and hold harmless, 905 game zone, their officers, officials, agents and or employees, from any and all liability for injury, disability and loss or damage to personal property. I freely assume all such risks both known and unknown and assume full responsibility for my participation. I have read and understand the rules and agree to fully comply with all regulations during my participation. If the party is held on a property owned by some person or organization other than the participant’s, it is understood that the event is in no way sponsored by the property owner and the property owner or their representatives assume no responsibility for the conduct of or safety of the event/activity. The participants shall hold harmless the property owner from any cause of action, claim, and petition arising from the use of the property related to 905 game zone.

RATING RELEASE: We take every reasonable precaution to ensure the your child is not subject to inappropriate material, however, you agree to release  905 game zone, directors, employees, staff and sponsors from liability resulting from willful or inadvertent exposure to such material. By signing below, I certify that I am the parent/legal guardian of the above named child, I have read, agreed and signed the parental consent form, and agree to accept all liability and responsibility for the actions of my child, and accept all liability resulting from my child’s use of equipment owned, operated or sold by 905 game zone.

PHOTO RELEASE: I agree to allow any photo/video taken of me or my child to be used for advertising 905 game zone (i.e. website, web pages, printed materials, newspaper, etc.). I acknowledge, understand and agree that I have read this consent form and assume all risk associated with participating and that I sign this release of liability voluntarily and without inducement.

All players under the age of 18 at the time of participation must have a parent or guardian sign below. I certify that I take legal responsibility for the above signed participant and/or responsibility of all party participants as indicated by the check box below. I also agree to indemnify the above named companies and individuals from all liabilities resulting from his/her participation in these activities for myself, my heirs, assigned and next of kin.

(Check one)

□ I am signing on behalf of all parents and party participants

□ I am signing on behalf of “player” listed above 

Parent/Guardian’s signature ____________________________________ Date:_______________