Anger Mangement Rage Room Waiver Form
Please read and sign the waiver before participating in the Rage Room experience.
Participant's Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
I hereby acknowledge that my participation in the Anger Management Rage Room experience is voluntary and undertaken at my own risk. I fully understand that this activity involves physical exertion, potential exposure to hazardous materials, and the inherent risk of injury, property damage, or other harm. I voluntarily assume all risks associated with participation and agree that neither Anger Management Rage Room, its owners, employees, nor agents shall be held liable for any injury, loss, or damage that may occur as a result of my participation.
I Agree
I Do Not Agree
I hereby release and hold harmless Anger Management Rage Room, its owners, employees, and agents from any and all claims, liabilities, or damages, including but not limited to personal injury, property damage, or other losses, arising out of or in connection with my participation in this activity.
I Agree
I Do Not Agree
I confirm that I am at least 18 years of age, or if under 18, I have obtained parental consent to participate in this activity.
I Agree
I Do Not Agree
I consent to photographs and videos being taken of me during my participation in ANGER MANGEMENT RAGE ROOM, and to publication of the photographs and videos by the Releasees for advertising, promotional and marketing purposes. I consent to video monitoring throughout the building and in individual rooms. I understand that my session may be stopped at any time as a failure to comply with instructions.
I Agree
I Do Not Agree
BLACK LIGHT (UV LIGHTING) DISCLOSURE AND ASSUMPTION OF RISK Certain areas or sessions within Anger Management Rage Room may use black lights (ultraviolet lighting) as part of the experience. Exposure to UV or flashing lights may cause discomfort or adverse reactions in individuals with photosensitivity, epilepsy, light-triggered migraines, or skin sensitivities. You acknowledge that you have been informed of this potential exposure and that you voluntarily assume all risks associated with participation under black light or UV lighting conditions. If you have any medical concerns, please consult a physician prior to participation.
I Agree
I Do Not Agree
Do you have any medical conditions or injuries that we should be aware of?
Signature of Participant
Signature of Parent/Guardian
Date
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Month
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Day
Year
Date
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