LIB01 #3689166 v2 Waiver .pdf

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Original filename: LIB01-#3689166-v2-Waiver.pdf
Title: LIB01-#3689166-v2-Waiver
Author: Erik Martin Bulichi

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Jump Island Customer Waiver and Voluntary Release
I understand and acknowledge, for myself and any minor in my care or custody, that there are certain
risks involved with the Jump Island activities in which I or they are about to voluntarily participate. I
understand that these risks, known or unknown, anticipated or unanticipated, may result in injury, death,
illness, or damage to myself, minor, others, or property, and I voluntarily agree to assume such risk and
responsibility for the occurrence of any such events..
I agree that in order to participate in the Jump Island activities at ___________________, I will hold
harmless Jump Island Franchising, LLC, _______________________(name of Franchisee) and
__________________(name of park) as well as their respective affiliates, officers, directors, owners,
employees, advertisers and promoters (“Releasees”), and voluntarily waive and release such Releasees
from any and all claims, causes of action, injuries, damages, losses and expenses. I fully acknowledge that
my participation and that of any minor in my care or custody is voluntary and understand the effect of this
waiver and release on my legal rights.
I hereby grant to Jump Island Franchising, LLC and _______________, their agents and respective
licensees, successors and assigns (herein collectively called “the licensed parties”) the right to use,
publish and copyright my name, picture, portrait or likeness, testimonial, voice, video, photographic
images, artwork in advertising, promoting and publicizing Jump Island products and services in any
media and in any manner or form throughout the world in perpetuity. I agree that any picture taken of me
by the licensed parties is owned by them.
By signing this Waiver and Release, I agree to the above terms and conditions for myself, my immediate
family, and any other guests that are a part of my group (including all minors) and my property.
My signature indicates that I have read the above rules and this entire document, understand it
completely, acknowledge that it cannot be modified or changed in any way by oral representations, and
agree to be bound by its terms. This agreement shall be binding on behalf of my heirs, assigns, and any
personal representative.
Participants Names (First and Last):
Adults:

Children:

I am the (father) (mother) (guardian) of the above mentioned minor(s). I consent to the foregoing
on behalf of such minor and personally join in the warranties and representations set forth above.
I also agree to indemnify and hold harmless the licensed parties with respect to any claims which
the minor(s) may make as a result of the exercise by the licensed parties of their rights hereunder.

BY SIGNING THIS DOCUMENT I HEREBY ACCEPT AND ASSUME ALL RISKS,
KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES,
COSTS, AN/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, OR DEATH,

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EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE
RELEASEES NAMED ABOVE.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND
HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OF ASSURANCE OF
ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL
RELEASE OF ALL LIABILITY. IF ANY PORTION OF THIS AGREEMENT IS HELD TO
BE INVALID, NOTWITHSTANDING, THE REMAINDER SHALL CONTINUE IN FULL
FORCE AND EFFECT.

Signature:

Date:

Name:
Address: ____________________________________________________________
City:

State:

Home Phone:

CELL:

Zip:

Email:
Emergency Contact:
Name:
Phone (cell):
Email:

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