Adventure Education Center/Supergames

December 13, 2012

ADVENTURE EDUCATION CENTER/SUPERGAMES

PERMISSION SLIP,

WAIVER AND RELEASE

YOU MUST HAVE THIS FORM COMPLETED AND SIGNED

TO PARTICIPATE,

BRING THIS WITH YOU TO THE PARTY!

PLEASE READ AND SIGN BELOW: This Waiver and Release covers all participants, including volunteers. Parents or guardians must complete and sign for all participants, including volunteers, under the age of 18 years. Volunteers must also sign the volunteer log and instructions at the time of the party.

Participation in all Adventure Education Center (AEC)/SuperGames activities, including the use of the AEC/SuperGames facilities, premises, and equipment, shall be at the sole risk of the undersigned. Please read the following information carefully and initial each paragraph to confirm that you have read and understand it.

______I/We understand that AEC/SuperGames activities may include inflatable devices. I/We understand that inflatable devices may have unstable and spongy surfaces and may involve a recoil action causing loss of balance.

______I/We understand that the risks of participation on inflatable devices and on artificial climbing structures may include, but are not limited to, bruises, abrasions, and cuts of the elbows, knees, and ankles; dizziness or vertigo; nausea; strains, sprains, or fractures of the knees, ankles, other joints, arms, legs, and spine; concussion and compression injuries caused by falling; loss of consciousness; coma; and death.

______I/We understand that the activity area of the AEC/SuperGames indoor facility may be uncomfortably warm during the summer months and whenever outdoor temperatures are high. I/We understand that such conditions may pose increased risk of illness to persons with asthma, other respiratory conditions, or cardiovascular conditions, and persons who are sensitive to heat. I/We understand that it is my/our responsibility to inform AEC/SuperGames staff of any such condition BEFORE participation in AEC/SuperGames activities.

______I/We understand all risks and hazards inherent in the facilities, premises, and equipment, and/or in participation in activities in the facilities and premises, of AEC/SuperGames. The undersigned, for himself/herself/themselves and/or any of his/her/their participating child(ren) under the age of 18 years, hereby waive(s) any and all claims, demands, damages, actions, or causes of action whatsoever, past, present, or future, known or unknown, arising out of or related to any loss, damage, or injury, including death, to persons or property arising out of or related to the use of the services, facilities, or premises of AEC/SuperGames, or of the equipment therein, by the undersigned. Further, the undersigned hereby agree to indemnify and hold harmless AEC/SuperGames, its officers, owners, agents, employees, coaches, and referees from any claim arising out of or related to the undersigned’s use of AEC/SuperGames facilities and premises and/or participation in AEC/SuperGames activities.

This Waiver and Release shall be binding on the heirs, next of kin, executors, administrators, personal representatives, and assigns of the undersigned. AEC/SuperGames is not responsible for lost or stolen items.

Participant’s/Volunteer’s/Parent’s or Guardian’s Name (Please Print)

Participant’s/Volunteer’s/Parent’s/Guardian’s Signature Date

(For participants under 18) Parent’s Emergency Contact Number ______

Child’s Name ______Gender ____ Age _____

Child’s Name ______Gender ____ Age _____

Child’s Name ______Gender ____ Age _____

Child’s Name ______Gender ____ Age _____

Child’s Name ______Gender ____ Age _____

For additional information about The Adventure Camp, after-school programs, corporate team building, company picnics, community festivals, school after-proms, or special events, please call 614-846-8946 or visit our web site at www.supergames.org. Thank you!