Please provide your details below and we will text you your team photo after the game!
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES at Back In Time, LLC 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 understand this activity has potential risks including but not limited to:
1) Use of simple tools
2) Potentially moving or lifting objects of not more than twenty pounds
3) Mental stress and anxiety
4) Being in a reasonably small space with a large group of persons
5) Possibility of failure to escape the room in the allotted time
6) Possibility of falling objects I have no physical or mental illness that precludes my participation in a safe manner for myself or others.
7) The risk to have contact with individuals or items touched by individuals, who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies does exist, and it is impossible to eliminate the risk that I could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume all full responsibility for my participation; 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 Back In Time LLC, 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. The undersigned further acknowledges that he/she has inspected the facilities, equipment, and areas to be used for Back In Time LLC and is voluntarily participating despite the risk of falls, contact and/ or crashes with other participants, defective equipment, the condition of the room and any hazards that may be posed by spectators or volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I agree that Back In Time LLC or any of its assign's has the right to any photos or any video/sound footage of me during the Back In Time LLC event. These photos, video footage and sound materials may be used for any marketing purposes. I fully understand that there are no refunds under any conditions except where expressly stated. 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 also understand that Back In Time, LLC recommends that I participate in this escape room experience with individuals with which I have been quarantined. I also understand that Back In Time, LLC will require all individuals (staff and clients) to utilize either surgical masks or cloth masks that cover both my mouth and nose at all times to reduce the risk of exposure to myself and others at all times while in the establishment and agree to abide by that requirement. I understand that upon entering the building Back In Time reserves the right to take my temperature using a touchless thermometer and if I have a temperature of 99 degrees or above, Back In Time, LLC reserves the right to refuse service to me and may ask me to leave immediately. I will then be able to rebook my appointment after 14 days or by providing proof of a negative COVID test.
I further understand that by signing this waiver, I attest that I am clear of the following symptoms and situations within the last 14 days leading up to my appointment:
-Fever of 99 degrees or above, or possible fever symptoms like alternating chills and sweating
-Cough
-Trouble breathing, shortness of breath or sever wheezing
-Chills or repeated shaking with chills
-Muscle aches
-Sore throat
-Diarrhea
-Loss of smell or taste, or a change in taste
-Headache
-Have had contact with an individual who has shown signs of the above symptom within the past 14 days
-Have been around anyone with confirmed COVID within the past 14 days
I understand that Back In Time, LLC reserves the right to refuse service to me and remove me from the premises if I fail to comply with the terms of this waiver, show signs of illness or are in any way combative.
By signing this waiver, I acknowledge and confirm that I am voluntarily participating in the activities or services associated with this room. I further agree that I will not dispute or contest any related transactions, fees, or charges associated with my participation, and I accept full responsibility for the financial commitment involved.By signing this waiver, I also understand that by entering a business open to the public, I am placing myself at risk to exposure of illnesses including but not limited to, the Coronavirus (also known as COVID-19), and will not hold Back In Time LLC liable for any symptoms of illness, medical costs, or other consequences resulting from illness. I further agree to contact Back In Time, LLC if I do develop symptoms within 14 days after my visit so Back In Time, LLC can take what they deem to be appropriate action in notifying other patrons or employees.
By signing below, I agree to comply with the written instructions above. I understand that failure to comply with these written instructions or verbal instructions from staff may result in my removal from the premises.