Veri Waiver
Veri Waiver
Veri Waiver
I, the undersigned individual, desire to participate in adventure course offerings at this location,
such as: SkyTrail + Sky Rail ropes course, Clip ‘n Climb climbing walls and structures, QUICKJump
free fall simulation, and/or SkyTykes + SkyRail children’s ropes course, (individually and
collectively referred to as the “Activity”) and otherwise use the equipment and facilities offered by
SkyTrail Connecticut, LLC d/b/a IT Indoor Adventure Ropes Course (the “Company”). As
consideration for the Company permitting me to participate in the Activity and use its equipment
and facilities, I, on behalf of myself and my spouse, children, parents, heirs, assigns, personal
representatives, and estate (collectively, “I”), agree to release, discharge, indemnify, defend, and
hold harmless the Company and each of their respective agents, aZliates, owners, oZcers,
members, participants, employees, suppliers, landlords, and all persons or entities acting in any
capacity on their behalf (collectively, “Releasees”), as follows:
1. ACKNOWLEDGMENTS: I acknowledge and certify: (i) I am at least 18 years old, do not have any
medical or physical condition(s) that would preclude me from participating in the Activity, and am
not intoxicated; (ii) I have read or otherwise been apprised of, and agree to comply with, all rules
relating to my participation in the Activity, as well as any instructions from the Activity operator(s);
and (iii) I have adequate insurance to cover any injury or damage I may cause or suffer while
participating in the Activity, or else I agree to bear the costs of such injury or damage myself.
2. ASSUMPTION OF THE RISKS: I acknowledge and understand that participating in the Activity
inherently entails known and unanticipated risks that could result in physical or emotional injury,
paralysis, death or damage to me, to property, or to third parties, including risks related to the
negligence or fault of any Releasee. I understand that such risks cannot be eliminated without
jeopardizing the essential qualities of the Activity. The risks include, among other things, bumps,
bruises, scrapes, tripping, bone fracture, concussion, and falling from heights, which could result in
musculoskeletal injuries including head, neck, and back injuries, paralysis, or even death. MY
PARTICIPATION IN THE ACTIVITY IS VOLUNTARY AND I ELECT TO PARTICIPATE DESPITE THE
RISKS.
4. USE OF LIKENESS. I understand that during the Activity and while I am otherwise using the
Company’s equipment and facilities I may be photographed or videotaped. To the fullest extent
allowed by law, I waive all rights of publicity and privacy and pre-approval that I have for any such
likeness of me or use of my name and/or voice in connection with such likeness, and I grant to the
Company and its assigns permission to copyright, use, and publish (including by electronic means)
such likeness of me, whether in whole or part, in any form, without restrictions, and for any
purpose.
5. ARBITRATION OF DISPUTES; WAIVER OF JURY TRIAL; TIME LIMIT TO BRING CLAIM; AND
CHOICE OF LAW: The parties agree that ANY AND ALL DISPUTES ARISING OUT OF THE ACTIVITY,
INCLUDING THE DETERMINATION OF THE SCOPE OR APPLICABILITY OF THIS AGREEMENT TO
ARBITRATE, SHALL BE BROUGHT WITHIN ONE YEAR OF ITS ACCRUAL (i.e., the date of the alleged
injury) AND BE DETERMINED BY ARBITRATION IN CONNECTICUT BEFORE ONE ARBITRATOR.
THE ARBITRATION SHALL BE ADMINISTERED BY JAMS PURSUANT TO ITS RULE 16.1 EXPEDITED
RULES AND PROCEDURES. JUDGMENT ON THE AWARD MAY BE ENTERED IN ANY COURT
HAVING JURISDICTION. THIS CLAUSE SHALL NOT PRECLUDE PARTIES FROM SEEKING
PROVISIONAL REMEDIES IN AID OF ARBITRATION FROM A COURT OF APPROPRIATE
JURISDICTION. This agreement shall be governed by and construed under the laws of
CONNECTICUT, without regard to conkicts of law provisions. Notwithstanding the provision with
respect to the applicable substantive law, any arbitration conducted pursuant to the terms of this
Agreement shall be governed by the Federal Arbitration Act (9 U.S.C., Sec. 1-16). I understand and
acknowledge that the JAMS Arbitration Rules to which I agree are available online for my review at
jamsadr.com, and include JAMS Comprehensive Arbitration Rule & Procedures; Rule 16.1
Expedited Procedures; and, Policy On Consumer Minimum Standards Of Procedural Fairness.
6. SEVERABILITY. The parties understand and agree that this agreement is intended to be as broad
and inclusive as is permitted by applicable law, and that if any portion of this agreement is found
to be void, invalid, or unenforceable, the remaining portions shall remain in full force and effect.
Participant Information
Personal
First Name
Timothy
Middle Name
James
Last Name
Nivison
Phone
8609608136
Gender
Male
Birth Date
Month
May
Day
4
Year
2005
Participant Address
Address Line 1
60 Kingswood Dr
Address Line 2
City
Southinton
State
CT
Zip Code
06489
Country
United States
Email Address
Email
[email protected]
Electronic Signature Consent
By checking below, you are consenting to the use of your electronic signature in lieu of an
original signature on paper. You have the right to request that you sign a paper copy
instead. By checking below, you are waiving that right. After consent, you may, upon
written request to us, obtain a paper copy of an electronic record. No fee will be charged
for such a copy and no special hardware or software is required to view it. Your
agreement to use an electronic signature with us for any documents will continue until
such time as you notify us in writing that you no longer wish to use an electronic
signature. There is no penalty for withdrawing your consent. You should always make sure
that we have a current email address in order to contact you regarding any changes, if
necessary.
Participant Signature
Signature
Sign Here*