ASSUMPTION OF RISK:I hereby acknowledge, accept and agree that the use of or participation in Breakthrough Anger Room, related activities, and the use of Breakthrough Anger Room’s services, equipment, and facilities is inherently dangerous. Participation in an anger room session and related activities may place unusual stresses on the body and is not recommended for persons suffering from asthma, epilepsy, cardio disorders, respiratory disorders, hypertension, skeletal, joint or ligament problems or conditions, and certain mental illnesses. Women who are pregnant or suspect they are pregnant and persons who have consumed alcohol or are otherwise intoxicated are not recommended to engage in anger room sessions. I have been advised to consult with my medical practitioner if I have any concern about my medical condition or fitness to engage in an anger room session. I have received full information regarding Breakthrough Anger Room’s services, equipment, and facilities and have had the opportunity to ask any questions that I had regarding the same. I have full knowledge of the nature and extent of all the inherent risks associated with anger rooms and the services, equipment, and facilities used in anger rooms and related activities at Breakthrough Anger Room, which may include but are not limited to:
a. Any and all manner of injury, including without limitation the possibility of serious injury or death, resulting from any of the services, equipment, and facilities at Breakthrough Anger Room’s, including without limitation, slipping or tripping on debris and hitting the floor, equipment, weapons, people or debris, whether permanently or temporarily in place, failure to wear protective gear, flying debris or any other consequence whatsoever of utilizing Breakthrough Anger Room’s services, equipment, and facilities;b. Injuries resulting from the actions or omissions of others, including but not limited to slips, trips and falls of other participants and flying debris;c. Cuts and abrasions resulting from skin contact with damaged items, debris, or any other surface, person, or equipment;d. Injuries resulting from shock, stress or other injuries;e. The aggravation or worsening of any existing medical condition;f. Failure or misuse of safety gear, weapons, or any other items or equipment;g. Failure to follow Breakthrough Anger Room’s employee instructions or failure to ask for information or assistance;h. Any injury that may occur while moving on or about the premises for any reason, including but not limited to slips, trips and falls, and any and all inherent risks of the use of or participation in a Breakthrough Anger Room, and the services, equipment and facilities used in Breakthrough Anger Rooms and related activities at Breakthrough Anger Room.I further acknowledge that the above list is not inclusive of all possible inherent risks associated with the use of Breakthrough Anger Room’s services, equipment, and facilities, and I agree that such list in no way limits the extent or reach of this Assumption of Risk, Release and Indemnification.
RELEASEIn consideration of my use of Breakthrough Anger Room’s services, equipment, and facilities, and/or participation in any program, competition, special event, group or party offered by or held at Breakthrough Anger Room, I hereby release and discharge Breakthrough Anger Room, as well as its members, managers, officers, directors, owners, employees, agents and contractors, from any and all liabilities, suits, claims, causes of action, demands, damages (including attorneys’ fees and expenses), losses or costs of any nature whatsoever incurred by me or that are in any way related to or arising out of the use or intended use of Breakthrough Anger Room’s services, equipment, and facilities, whether supervised or not, including, without limitation, all claims for property damage, personal injuries or wrongful, whether or not there are any allegations or charges of negligent acts or omissions on the part of any other parties, including Breakthrough Anger Room (collectively, the “Claims”).
MEDIA RELEASEI do hereby give to Breakthrough Enterprises LLC, their related persons, entities, assigns, licensees, successors in interest, legal representatives, and heirs (here forth referred to as "Breakthrough Anger Room") the irrevocable right to use my name (or any fictional name), quotes, image, picture, portrait, photograph, video, and/or audio (here forth referred to as "works") in all forms and in all media and in all manners, without any restriction as to changes or alterations (including but not limited to composite or distorted representations or derivative works made in any medium) for advertising, trade, promotion, exhibition, or any other lawful purposes, and I waive any right to inspect or approve the works or finished version(s) incorporating the photograph(s), including written copy that may be created and appear in connection therewith.
I hereby release and agree to hold harmless Breakthrough Anger Room from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the works or in any processing tending toward the completion of the finished product, unless it can be shown that they and the publication thereof were maliciously caused, produced, and published solely for the purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity. I agree that Breakthrough Anger Room owns the copyright of the works and I hereby waive any claims I may have based on any usage of the works or derivatives of the works, including but not limited to claims for either invasion of privacy or libel. I am of full age and competent to sign this release or I am legally able to give such consent. I agree that this release shall be binding on me, my legal representatives, heirs, and assigns
INDEMNIFICATION:I hereby agree to indemnify Breakthrough Anger Room, as well as its members, managers, officers, directors, owners, employees, agents and contractors, from any and all liabilities, suits, claims, causes of action, demands, damages, losses or costs of any nature whatsoever arising out of, or in any way relating to, my use of or movement in or throughout Breakthrough Anger Room’s services, equipment, and facilities, whether or not there are any allegations or charges of negligent acts or omissions on the part of any other parties, including Breakthrough Anger Room.I understand and agree that Breakthrough Anger Room and its personnel or staff reserves the right to deny access to its facilities to any individual, permanently or for a specified period of time, for any breach of Breakthrough Anger Room’s policies, rules and regulations, for any conduct that is viewed as unsafe or inappropriate, or for any other reason whatsoever, whether disclosed or not. While using Breakthrough Anger Room’s services, equipment, and facilities, I consent to Breakthrough Anger Room capturing any form of media containing my image, be it photo or video, and agree that any such media may be used for any and all purposes that Breakthrough Anger Room deems appropriate in its sole and absolute discretion. Breakthrough Anger Room may add my email address to their mailing list for Breakthrough Anger Room updates and promotions.This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns, in the event of my death or incapacity. By signing this agreement, I waive the right to bring a court action to recover damages or obtain any other remedy for any injury to myself or death, or any damages to my property, however caused, arising out of my use of or movement in or throughout Breakthrough Anger Room’s services, equipment, and facilities, now or any time in the future, whether or not there are any allegations or charges of negligent acts or omissions on the part of any other parties, including Breakthrough Anger Room. I agree to pay for any and all reasonable attorneys’ fees and expenses incurred by Breakthrough Anger Room as a result of any claims made by me or on my behalf in contravention of this agreement.
I am at least 18 years of age and legally competent to sign this agreement. This Assumption of Risk, Release and Indemnification shall be effective and binding upon me and upon my assigns, heirs, representatives, executors and administrators. If I am under the age of 18, this release must also be signed and filled out below by my parent or guardian.My participation in this activity is purely voluntary, and I elect to participate in spite of the risks described herein. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or I will otherwise agree to bear the costs of such injury or damage. I further certify that I have no medical or physical conditions which interfere with my ability to participate safely in the use of Breakthrough Anger Room’s services, equipment, and facilities, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.
In the event that I file a lawsuit against Breakthrough Anger Room, I agree to do so solely in the state of Virginia, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
I have had sufficient opportunity to read this entire document, as well as the opportunity to ask questions about this document if I have any. By signing this agreement, I acknowledge that if anyone is hurt or property is damaged while I am on the premises, I may be found by a court of law to have waived my right to maintain a lawsuit against Breakthrough Anger Room’s, as well as its members, managers, officers, directors, owners, employees, agents and contractors, on the basis of any claim from which I have released them herein.