Complete a waiver for myself
Complete a waiver for myself and children

Adult Information

(  Indicates a required field )

( Age must be at least 18 years old )

Contact Information

    Liability Waiver

Please read the waiver below and fill out the required fields found in the following form sections. All liability language from the waiver will apply to all household members listed below.

EXPRESS ASSUMPTION OF RISK, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT


This Express Assumption of Risk, Release of Liability, Waiver of Claims, and Indemnity Agreement (the “Agreement”) is entered into for and in consideration of Valley Jump, LLC, its past, present and future agents, servants, members, owners, directors, officers, employees, volunteers, affiliates, subsidiaries, lessors and all other related entities, their successors and assigns (cumulatively referred to as “Released Persons”) permitting the Adult Participant and/or Guardian, _________________________________ (herein “Participant’), and/or any Minor Participant(s) (all such Minor Participants shall be listed at the end of this form and no persons are permitted use of the facilities unless listed on this form), being an individual(s) under the age of eighteen years of age (18) (herein, “Minor” Participant(s)”), to use the equipment and facilities (including, but not limited to, the parking facilities) and/or observe and/or engage in the activities (herein “Activity Participation”) of Valley Jump, LLC, I, the Participant and/or being the natural guardian or legal guardian of the Minor Participant(s), and authorized to sign this Release, hereby agrees as follows on their own behalf and on behalf of all Minor Participatns:


  1. Assumption of Risk: Understanding the risks involved, I voluntarily choose to participate in Activity Participation, and EXPRESSLY ASSUME the associated risks, including the risk of injury and death, whether caused by the negligence of any of the Released Parties or any other cause. I accept full and complete responsibility for the safety of myself, any guests or observers accompanying me or present at my invitations and personal property. Further, I assume the risk of damage or injury caused by myself or those at my invitation, and INDEMNIFY the Released Parties against any claims for damages to persons or property caused by me or my invitees.  Some of the risks resulting from my and/or the Minor Participant(s) Activity Participation include, but are not necessarily limited to, scrapes, cuts, bruises, serious injuries to one’s person, muscle sprains, bone fractures, muscle injuries, and other injuries resulting from my medical conditions and/or the acts or omissions of other participants.  I fully understand and accept for myself and on behalf of the Minor Participant(s) these risks as well as any other risks unknown to me at the time of the signing of this Release.

  2. Release of Claims: On behalf of myself, the Participant, my spouse, my domestic partner, my children, my family members, my heirs, successors, assigns, representatives, trustees, executors, any one acting for or on behalf of my estate and/or for and on behalf of the Minor Participant(s) his or her spouse, parents and/or next friend, and/or legal guardian, and/or such Minor Participant(s) heirs, successors, assigns, representatives, executors and/or anyone acting for or on behalf of such Minor Participant(s)’s estate,  I HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASED PARTIES, JOINTLY AND SEVERALLY, FROM ALL CLAIMS, ACTIONS, DEMANDS, RIGHTS, CAUSES OF ACTION AND LIABILITIES, IN LAW OR IN EQUITY, WHETHER MY OWN OR DERIVATIVE CLAIMS, BASED UPON ANY BODILY INJURY OR DISABILITY, ILLNESS OR DISEASE, DEATH, FINANCIAL LOSS, PROPERTY LOSS, DAMAGE DESTRUCTIONS OR OTHER HARM OF WHATEVER NATURE, WHETHER FORESEEN OR UNFORESEEN, THAT MAY BE SUFFERED OR SUSTAINED BY ME OR BY ANY OTHER PERSON AS A DIRECT OR INDIRECT CONSEQUENCE OF MY PARTICIPATIONS IN ACTIVITY PARTICIPATION, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASED PARTIES OR OTHERWISE, provided, however, nothing contained herein shall be deemed to release any Released Party from liability arising from their own willful or intentional injury to me or my property.

  3. Promise Not to Bring Suit: I hereby agree that I, my heirs, successors in interest, guardians, personal representatives, legal representatives and assigns will not bring a claim against, sue, demand compensation from or attach the property or assets of the Released Parties or any of the them, either in my name or their own name, for any loss or damage arising or resulting directly or indirectly from my participations in Activity Participation or my presence at the Released Parties’ premises.

  4. Indemnification: I agree to INDEMNIFY, DEFEND AND HOLD HARMLESS each of the Released Parties from and against any and all claims, suits, demands, liabilities, damages, losses, costs and expenses, including but not limited to attorney’s fees arising from or in connection with the injury, illness or death of any person or the damage, destruction or loss of any of my property or others’ property which might result, directly or indirectly, from my participation in Activity Participation.  I voluntarily agree to defend, indemnify and hold harmless the Released Persons from any and all Claims, (the term “Claims” being defined as any and all theories of recovery of whatsoever nature, for personal injury and/or property damage and/or wrongful death, whether known or now unknown, recognized by the law of any jurisdiction and comprehensively includes, but is not limited to, causes of action, allegations, demands, liability, suits, charges, and judgments, whether arising in equity or under the common law or any contract or any statute, or otherwise), which arise directly or indirectly from my and/or the Minor Participant(s)’s Activity Participation,  in the facilities owned and operated by one or more of the Released Persons, including, but not limited to, ALL CLAIMS THAT ALLEGE NEGLIGENT ACTS OR OMISSIONS OF ONE OR MORE OF THE RELEASED PERSONS, herein “Claims”).

  5. Unpredictable Causes and Personal Responsibility: I on behalf of myself and/or the Minor Participant(s), accept, agree, fully acknowledge, and understand that one or more of the Released Persons may commit negligent acts or omissions in monitoring, operating, supervising and/or maintaining the equipment and facilities owned and/or operated by one or more of the Released Persons.  I accept and/or on behalf of the Minor Participant(s) accept the risks of personal injury, death and/or property damage resulting from a Released Person’s negligent acts or omissions that may occur in the operating, monitoring, supervising and/or maintaining the equipment and facilities owned and operated by one or more of the Released Persons and agree that the terms and provisions of this Release shall be fully applicable even though one or more of the Released Persons has committed a negligent act(s) or omission(s).

  6. Statement of Good Health: I certify that I and/or the Minor Participant(s) is in good health and physically able to safely participate in Activity Participation. I certify neither I nor the Minor Participant(s) is, or any time during Activity Participation will be, under the influence of alcohol or any medication or other substance, whether obtained, legally or illegally, which would impair my and/or the Minor Participant(s)’s ability to safely participate in Activity Participation. I fully understand that the Released Persons lack knowledge of my and/or the Minor Participant(s) medical and/or physical condition which may result in an `injury to me and/or the Minor Participant(s) and/or other persons, and voluntarily assume any and all risks of injury to me and/or the Minor Participant(s) associated with engaging in Activity Participation in my and/or the Minor Participant(s)’s medical and physical condition.

  7. Virginia Law; Jurisdiction; Venue: If I, or an individual or entity acting on my behalf and/or a Minor Participant’s behalf, files one or more Claims, as hereinafter defined, or any legal action against any one or more Released Persons, I agree that the substantive and procedural law of the State of Virginia shall apply in that action without regard to choice of law provisions of the State of Virginia.  The sole Venue, aside from Arbitration as hereafter defined, shall be in the Courts of Harrisonburg/Rockingham County, Virginia.

  8. Severability: I, on behalf of myself and/or the Minor Participant(s), further agree that if any portion of this Release is found to be unenforceable or void for any reason by an arbitrator or court of competent jurisdiction, the remaining provisions of this Release shall remain in full force and effect.

  9. Arbitration: I, on behalf of myself and/or the Minor Participant(s), agree to submit any controversy, claim or dispute arising out of or related to the execution, interpretation, performance or breach of this Release, including, but not limited to, the scope of this arbitration provision and the my compliance with this paragraph to engage in binding arbitration administered by Juridical Solution, utilizing the applicable rules of the American Arbitration Association, in Rockingham County, Virginia. In addition to any other powers the arbitrator may have under the rules of the AAA, and the laws of the state of Virginia, the arbitrator shall have all jurisdiction and power to make rulings as to procedures for the conduct of the arbitration; to declare rights of the parties; to grant temporary and permanent injunctive and other equitable relief; to order specific performance of contractual obligations; to grant compensatory damages; to determine the admissibility, relevance, materiality and weigh of any evidence offered by any of the parties (except that affidavits alone may not be admitted in lieu of in person testimony); to allow depositions for evidence; to render orders facilitating or compelling discovery. The decision of the arbitrator shall be in accordance with the laws of the state of Virginia. Any party may apply to the Circuit or Chancery Court of Rockingham County, Virginia for confirmation or enforcement of the arbitrator’s decision.  The Arbitrator’s decision shall state the factual and legal basis for the decision. The arbitrator’s award shall be final and binding on the parties, except as provided by applicable law. The cost of the arbitration shall initially be shared by the parties. Provided however, the arbitrator may award the prevailing party the cost of the arbitration proceeding as a part of the award, including the prevailing party’s legal fees and expenses. The cost of the arbitration shall mean the cost of the arbitrator. Juridical Solutions shall provide a panel of three (3) arbitrators. Each party to the arbitration shall have the right to strike one arbitrator. If one arbitrator remains, that arbitrator shall be the selected arbitrator. If more than one arbitrator remains, Juridical Solutions shall select the arbitrator from the remaining arbitrators. The arbitrator’s award shall be final and neither party shall have the right of appeal.

  10. Digital Rights: I and/or on behalf of the Minor Participant(s) agree, authorize and consent to one or more Released Persons photographing, videoing and otherwise recording my and/or the Minor Participant(s)’s Activity Participation for any reasonable purpose, including, but not limited to, advertising in any manner and in all media, without restriction, to include, but not be limited to, World Wide Web sites relating to Valley Jump, LLC.  I and/or on behalf of the Minor Participant(s), voluntarily waive any right to inspect or approve any photograph of me and/or the Minor Participant(s) and agree that any use of any photo, video or recording of me by Valley Jump, LLC shall be without compensation.  I and/or on behalf of the Minor Participant(s), agree that all photographs, videos and recordings are the exclusive property of the Valley Jump, LLC, and I and/or on behalf of the Minor Participant(s), waive my expectation of privacy and the right to inspect and/or approve the use of the photographs, videos and/or recordings.  Further I consent to the Released Persons using my name, likeness, voice, or image for promotional purposes.

  11. Authority to Act: I agree that this Release is made for me and/or on behalf of the Minor Participant(s) and the releases, waivers and promises contained herein are binding on me and/or the Minor Participant(s) and all persons claiming by through or under me and/or the Minor Participant, including but not limited to, his/her natural or legal guardians, as fully and completely as though the Minor Participant(s) were an adult of legal age in the State of Virginia and had executed this Release. I also represent to Valley Jump, LLC as a material inducement to Valley Jump, LLC to allow the Minor Participant(s) to engage in Activity Participation, that I have full authority, either as the natural guardian (parent) or legal guardian for the Minor Participant(s)’s to agree to the terms and provisions of this Release.

  12. Term: I agree that this Release shall be binding on me and the Minor Participant(s) named herein, my and/or the Minor Participant(s)’s heirs, successors and assigns, natural guardians, parents, next friend, legal guardian and anyone making a Claim by, through or under me and/or the Minor Participant(s) and shall continue in full force and effect and govern any Activity Participation by me and/or the Minor Participant(s) named herein, in perpetuity.

  13. Rules/Regulations: I and/or on behalf of the Minor Participant(s) agree to comply in all respects with rules adopted from time to time by Valley Jump, LLC governing Activity Participation.

  14. Waiver of Jury Trial: I AND/OR ON BEHALF OF THE MINOR PARTICIPANT(S) UNDERSTAND AND AGREE TO WAIVE ALL OF MY AND/OR THE MINOR PARTICIPANT(S) RIGHT TO A JURY TRIAL UNDER THE LAWS OF THE STATE OF VIRGINIA IN THE EVENT SUCH RIGHT TO A JURY TRIAL SHOULD BE AVAILABLE TO ME OR THE MINOR PARTICIPANT.

  15. Signature: I  agree that my (the Participant) Electronic Signature [whether digital or encrypted] and/or for or on behalf of the Minor Participant(s) attached to or logically associated with this Release executed or adopted with the intent to authenticate this Release shall have the same force and effect as an  original manual signature.  For purposes of this Release, Electronic Signature means any electronic sound, symbol or process attached to or logically associated with this Release and executed and adopted by me, the Participant and/or by me for and on behalf of the Minor Participant(s) with the intent to sign this Release. I agree that Electronic Signature by me for myself and/or on behalf of the Minor Participant(s) includes, but is not limited to, the following transmission methods:

    1. My typed name at the end of an e-mail accompanying the Release.    

    2. A digital signature using public key encryption technology.

    3. As an online user, my clicking a button to verify I  agree with the terms of this Release.

  16. I agree, if I am signing for or on behalf of one or more Minor Participant(s), that all provisions contained herein shall be fully applicable to such Minor Participant(s) and such Minor Participant’s Activity Participation.


            IN WITNESS WHEREOF, the undersigned has executed this Release Agreement on the date set forth above.



Signature:    __________________________________________________________________

Adult Participant and/or Guardian’s Name (printed): _________________________________________________________________________

Minor Participants (printed):  ______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Adult Participant and/or Guardian’s Address: ______________________________________________________________________________

______________________________________________________________________________

Adult Participant and/or Guardian’s Phone Number: ___________________________________

Date: ______________________



            CAUTION – READ CAREFULLY – THIS IS A RELEASE OF RIGHTS

  I acknowledge I have read and understand this waiver and certify that all personal information is correct.
  I do not wish to allow my email to be used for marketing purpose.
By signing this waiver, I agree that all information is complete and accurate.