Broke Axe LLC
BROKE AXE LLC
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS EVENT, including by
way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities
being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their
possible liability without fault.
I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to
not participate by a qualified medical professional. I certify that there are no health-related reasons or problems that preclude my
participation in this activity.
I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of
the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.
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 including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS:
Broke Axe LLC/or their owners, directors, officers, employees, volunteers, representatives, and agents, and the activity holders,
sponsors, and property owners.
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in (A) 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 Broke Axe LLC, and their owners, directors, officers, volunteers, representatives, and agents 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 acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death,
serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather,
condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to,
participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also
present for volunteers.
I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during
I understand that while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be
used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.
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 CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE
OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
I CERTIFY THAT IF PARTICIPANT IS A MINOR: I am the parent or legal guardian of the minor. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release of Liability and Waiver of Claims. And Certify the minor is 12 years or older.
Powered by EscapeWaivers.com