Waiver - Shatter Zone
Participation Waiver, SHATTER ZONE, LLC.

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND
INDEMNITY AGREEMENT (Hereinafter the “Release Agreement”). BY SIGNING
THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS,
INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN
ACCIDENT. PLEASE READ CAREFULLY!
Must be completed for participants age 18 and older, or 13 to 17 by a parent or legal
guardian (Print up to three names/birthdates below of children of the SAME parent or
legal guardian):

In consideration for gaining access to, 1028 Campbell St. suite A, Jackson, TN 38301,
(the “Location”), and engaging the services of SHATTER ZONE, LLC. d/b/a SHATTER
ZONE Rage Room at the Location, on behalf of myself, my spouse, my children, my
parents, my heirs, assigns, personal representatives, estate, and insurers, I hereby
release, Indemnify, hold harmless, and discharge SHATTER ZONE, LLC., d/b/a
SHATTER ZONE, Rage Room, SHATTER ZONE, LLC. their agents, owners, officers,
affiliates, volunteers, participants, employees, insurers and all other persons or entities
acting in any capacity on their behalf (herein after collectively referred to as
“SZLLCSZ”), as follows:
MEDICAL CONDITION
I understand that use of the SHATTER ZONE rage room may place unusual
stresses on the body. Use of rage rooms are not recommended for persons
suffering from asthma, epilepsy, cardio/respiratory disorder, hypertension, or
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, are not recommended to engage in the rage room. I have
been advised to consult with my medical practitioner if I have any concern about
my medical condition or fitness to engage in the rage room.

ASSUMPTION OF RISKS
I acknowledge and I am aware that my participation in SZLLCSZ rage room or activities
entails known, unanticipated, unusual risks, hazards, and dangers that could result in
physical or emotional injury, including, but not limited to: accidents which may occur in
the facility; slips and falls; malfunction of the equipment used; injury and open wounds;
shock, broken bones, shock, sprained or torn ligaments, paralysis, incapacity, death, or
any other bodily injury or property damage to myself, or to third parties while
participating in the rage room; negligence on the part of other persons; and
NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT
NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE
REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS,
DANGERS AND HAZARDS OF THE RAGE ROOM.
● I understand that such risks simply cannot be eliminated without jeopardizing the
essential qualities of the activity. I expressly agree and promise to accept and
assume all of the risks existing in this activity on behalf of myself and/or my
children. My participation in this activity is purely voluntary and I elect to
participate in spite of the risks.
● If I and/or my child are injured, I acknowledge that I may require medical
assistance, which I acknowledge will be at my own expense or the expense of
my personal insurer(s). I hereby represent and affirm that I have adequate and
appropriate insurance to provide coverage for such medical expense. I
UNDERSTAND AND AGREE THAT SZLLCSZ WILL NOT PAY FOR ANY COST
OR EXPENSES INCURRED BY ME IF I AND/OR MY CHILD ARE INJURED.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of the Releasees agreeing to my participation in the rage
room, and permitting my use of the SHATTER ZONE, LLC’s equipment, room and
other facilities, I hereby agree as follows:
TO WAIVE ANY AND ALL CLAIMS AND TO RELEASE THE RELEASEES from any
and all liability for any loss, damage, expense or injury including death that I may
suffer, or that my next of kin may suffer, as a result of my participation in the rage
room, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH
OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE,
INCLUDING ANY DUTY OF CARE ON THE PART OF THE RELEASEES. I
UNDERSTAND THAT NEGLIGENCE INCLUDES THE FAILURE ON PART OF THE
RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME
FROM THE RISKS, DANGERS AND HAZARDS OF THE RAGE ROOM;
● TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all
liability for any property damage or personal injury to any third party resulting
from my participation in the Rage Room;
● This Release Agreement shall be effective and binding upon my heirs, next of
kin, executors, administrators, assigns and representatives, in the event of my
death or incapacity;
● This Release Agreement shall be effective and binding upon my heirs, next of
kin, executors, administrators, assigns and representatives, in the event of my
death or incapacity;
● I hereby voluntarily release, forever discharge, and agree to defend, indemnify,
and hold harmless SZLLCSZ from any and all claims, demands, or causes of
action, which are in any way connected with my and/or my child(ren)’s
participation in SZLLCSZ activities and/or my and/or my child(ren)’s use of
SZLLCSZ’s equipment or facilities including, but not limited to, any such claims
based upon damages caused or alleged to have been caused in whole or in part
by the negligent acts or omissions of SZLLCSZ.
● Should SZLLCSZ or anyone acting on their behalf, be required to incur attorney’s
fees and costs to enforce this Agreement, I agree to indemnify and hold them
harmless for all such fees and costs. I certify that I am physically able to
participate in all activities at the Location without aid or assistance. I further
certify that I am willing to assume the risk of any medical or physical condition
that I may have.
● I acknowledge that I have been provided with a copy of the rules, (the “SZLLCSZ
Rules”) governing my and/or my child(ren)’s participation in any activities at the
Location. I certify that I have explained the SZLLCSZ Rules to the child(ren)
listed in this waiver. I understand that the SZLLCSZ Rules have been
implemented for the safety of all quests at the Location, including myself and/or
my child(ren). I acknowledge that failure to follow the rules could result in the
expulsion of myself and/or my child(ren) from the Location. I agree that if any
portion of this Agreement is found to be void or unenforceable, the remaining
portions shall remain in full force and effect. This Release Agreement and any
rights, duties and obligations as between the parties to this Release Agreement
shall be governed by and interpreted solely in accordance with the laws of the
State of Tennessee and no other jurisdiction;
● This Release Agreement and any rights, duties and obligations as between the
parties to this Release Agreement shall be governed by and interpreted solely in
accordance with the laws of the State of Tennessee and no other jurisdiction;
● If there are any disputes regarding this agreement, I on behalf of myself and/or
my child(ren) hereby waive any right I and/or my child(ren) may have to a “trial”
which means (that the person signing the Agreement is waiving their right to sue
or go to court to secure relief). I agree that such dispute shall be brought within
one year of the date of this Agreement and will be determined by binding
arbitration before one arbitrator to be administered by NAM (National Arbitration
and Mediation) pursuant to its Comprehensive Arbitration Rules and
Procedures.Any arbitration involving the parties to this Release Agreement will
take place solely within the City of Jackson and shall be within the exclusive
jurisdiction of the State of Tennessee. If, despite the representations made in this
agreement, I or anyone on behalf of myself and/or my child(ren) file or otherwise
initiate a lawsuit against SZLLCSZ, in addition to my agreement to defend and
indemnify SZLLCSZ, I agree to pay within 60 days liquidated damages in the
amount of $5000 to SZLLCSZ. Should I fail to pay this liquidated damages
amount within the 60 day time period provided by this Agreement, I further agree
to pay interest on the $5000 amount calculated at 12% per annum.
● I further grant SZLLCSZ the right, without reservation or limitation, the right to
photograph, videotape and/or record me/and or my child(ren) and to use my or
my child(ren’)s name, face, likeness, voice, and appearance in connection with
exhibitions, publicity, advertising, and promotional materials. I would like to
receive free email promotions and discounts to the email address provided
below. I may unsubscribe from emails from SHATTER ZONE at any time.
● I further grant SZLLCSZ the right, without reservation or limitation, to videotape
and/or record me and/or my child(ren) on closed circuit television.
By signing this document, I acknowledge that if anyone is hurt or property is damaged
during my participation in this activity, I may be found by a court of law to have waived
my right to maintain a lawsuit against SZLLCSZ on the basis of any claim from which I
have released them herein. I have had sufficient opportunity to read this entire
document. I understand this Agreement, and I voluntarily agree to be bound by its
terms. I further certify that I am the parent or legal guardian of the child(ren) listed above
on this Agreement or that I have been granted power of attorney to sign this Agreement
on behalf of the parent or legal guardian of the child(ren) listed above.

Parent/Legal Guardian’s Signature: _________________________________________
Print Name: ________________________________ Date: ______________________
Email Address__________________________________________________________
Parent/Guardian/Participant (if over 18): First Name Last Name Birth date Street
Address Apt. # City State ZIP Cell Phone Emergency Contact Number Email Participant
Signature (if 18 or older): __________________________________Date: __________
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Full Name *
Participant's Date of Birth *
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Today's Date *
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Are you 18 or older? *
Required
Do you accept the terms and the conditions of this waiver? *
Required
Parent/Legal Guardian's Signature: *
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