PARTICIPATION WAIVER | ASSUMPTION OF RISK

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PARTICIPATION WAIVER | ASSUMPTION OF RISK AGREEMENT Knockerball Minnesota, LLC

Participant’s First Name Last Name

Email Address

Parent/ Guardian Name

1. 2.

3.

4. 5.

6.

7.

M/F

Date of Birth Age

Phone Number

Emergency Contact (if different) Emergency Contact Phone #

I, the parent or guardian of the registrant, a minor, agrees that the registrant and I will abide by the rules and Code of Conduct of Knockerball Minnesota, LLC. I certify that the age of the registrant listed is correct and the registrant is physically fit to engage in structured and unstructured activities with Knockerball Minnesota, LLC. I agree that if at anytime I believe conditions or equipment to be unsafe, I will have my child discontinue participation in the activity. I recognize the possibility of physical injury associated with activities with Knockerball Minnesota, LLC. I hereby release Knockerball Minnesota, LLC, their employees, and associated personnel against any claim by or on behalf of the registrant’s participation in the programs / events. I, as the parent or legal guardian, give consent for emergency treatment under whatever conditions are necessary to preserve life, limb or well being of my dependent. I fully understand that activities involve risks and dangers of serious bodily injury including permanent disability, paralysis and death. These risks may be caused by my child’s actions, inactions, or the actions or inactions of others. I fully accept and assume all such risks and all responsibility of losses, costs, and damages I may incur as a result of my child’s participation. I acknowledge that Knockerball Minnesota, LLC and its employees or assigns may from time to time take photographs, videos, or tape recordings relating to my child’s participation in said activities. I understand that these products are the property of Knockerball Minnesota, LLC and maybe used at their discretion without additional notice, authorization or compensation. I have read this agreement and fully understand its terms and have signed it freely. I agree that if any portion of this agreement is held to be invalid, the balance shall continue in full force and effect. I agree to have my email address entered into an email service company for facility group emails.

Participant (over 18)/ Parent/ Legal Guardian Signature (Parental Acknowledgment for ages 17 and under)

Date