Whole Brain Escape - Waiver
410 Upchurch Street, Apex, NC 27502     (919) 355-2714
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YOUR FIRST AND LAST NAME:
(NOTE:
 YOU CANNOT FILL THIS OUT FOR ANOTHER ADULT. IF YOU ARE FILLING THIS OUT FOR SOMEONE WHO IS UNDER 18, WRITE YOUR FIRST AND LAST NAME HERE, EVEN IF YOU WON'T BE PLAYING. THEN LIST THE CHILDREN AT THE BOTTOM OF THIS FORM.)
*
Waiver
By signing this waiver, I hereby assume all risks of participating in events hosted by Media Sunshine, Inc DBA Whole Brain Escape. I agree to fully and forever release, indemnify, and hold harmless Media Sunshine, Inc.

These game activities simulate dangerous and highly stressful situations, meant to test a person’s physical or mental limits, which may cause mental and physical duress or injury. I certify that I understand this activity has potential risks, including by not limited to:
Use of simple tools;
Potentially moving or lifting objects of less than 10 pounds;
Mental stress and anxiety;
Being in an enclosed space with a group of up to 12 people
Failing to complete the objectives in the allotted time 


I have no physical or mental illness that precludes my participation in a safe manner for myself or others. I am not under the influence of drugs or alcohol which impairs my ability to maintain my safety awareness or endangers others.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. I agree that all staff or authorized agents may, in their sole discretion, determine it is unsafe for myself or others for my participation to continue, remove me from the premises by any lawful means.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, THE FOLLOWING ENTITIES OR PERSONS: The directors, officers, employees, volunteers, representatives, and agents of any and all entities authorizing this activity;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that the directors, officers, employees, volunteers, representatives, and agents of any authorizing entity are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I acknowledge that I will not take pictures/video inside the escape room.

If any photos are videos are taken while in the escape room, the game will be immediately terminated and media will be deleted.

I will not disclose trade secrets or puzzles from Whole Brain Escape. Whole Brain Escape reserves the right to prosecute any action that is a violation of this agreement.
Group Photos
I understand that after the game, there will be an optional group photo in the lobby. Participation in the group photo constitutes agreement to have one's photo or video likeness to be posted on Whole Brain Escape's Facebook, Instagram, or other social media channels.
Email Address *
From time to time, Whole Brain Escape will send out emails about new games, contests, and local events. Would you like to receive email updates? *
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How did you hear about us?
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IF ANYONE UNDER THE AGE OF 18 IS IN THE GROUP, WRITE THEIR NAMES AND AGES HERE:
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