Release and Waiver of Liability
I acknowledge and understand that there are dangers and risks associated with the use of virtual reality equipment which includes, but not limited to: dizziness, nausea, vomiting, short breath, pallor, headaches, disorientation, fatigue, seizures, impaired hand-eye coordination or balance, eye strain, blackouts, discomfort, loss of awareness, altered, blurred, or double vision or other visual abnormalities, excessive sweating, increased salivation, drowsiness, or any symptoms associated with motion sickness. I acknowledge the known and unanticipated risks that can result in physical injuries to myself and others, emotional injury, death, and damage to personal, public, third party, and HACK IT LLC (DBA Blurscape) property. By participating in the activities provided by HACK IT LLC (DBA Blurscape), I freely and fully assume and agree to the hazards and risks, and to use my best judgment while engaging in those activities.

I agree to indemnify and hold harmless HACK IT LLC (DBA Blurscape) against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If HACK IT LLC (DBA Blurscape) incurs any of these types of expenses, I agree to reimburse HACK IT LLC (DBA Blurscape).
I acknowledge that HACK IT LLC (DBA Blurscape) and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of HACK IT LLC (DBA Blurscape).
I acknowledge that this activity may involve a test of a person’s physical and mental limits. I further acknowledge that it carries with it the possibility of serious injury, death, or property loss. The risks include, but are not limited to, those caused by terrain, facilities, weather, temperature, dehydration, and the condition of equipment and vehicular traffic, as well as the actions of other people.
I understand that, except as HACK IT LLC (DBA Blurscape) agrees to in writing, HACK IT LLC (DBA Blurscape) does not carry or maintain medical, health, or disability insurance coverage for its participants. I am expected and encouraged to obtain my own medical or health coverage.
In the event that any damage to equipment or facilities occurs as a result of my willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.
This waiver shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I agree that in the event that any clause or provision of this waiver and release shall be held invalid by any court of competent jurisdiction, the invalidity of such a clause or provision shall not otherwise affect the remaining provisions of this waiver and release, which shall continue to be enforceable.
I will not use the virtual reality equipment:
1. If I have any communicable or infectious disease or illness, skin disorder, large cuts, open sores or wounds;
2. If I am under the influence of alcohol or drugs;
3. If I am epileptic, unless in my opinion of my physician, my epilepsy is under medical control so that I am in sufficient control of my seizures not to endanger myself.
I understand that any items I bring to HACK IT LLC (DBA Blurscape), including, but not limited to: camera, MP3 player, cell phone, other personal electronics, jewelry, glasses, etc., are the responsibility of myself, and HACK IT LLC (DBA Blurscape) is in no way responsible for lost, missing, stolen, or damaged items.
By entering HACK IT LLC (DBA Blurscape) location or premises, I authorize HACK IT LLC (DBA Blurscape) to use the following personal information:
1. My picture - including photographic, motion picture, and electronic (video) images.
2. My voice - including sound and video recordings.
I hereby grant HACK IT LLC (DBA Blurscape) , its subsidiaries, successors, assignees, the right to use, publish, and reproduce, for all purposes, my name, pictures, of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences, and in brochures and other print media.
This permission extends to all languages, media, formats, and markets now known or hereafter devised. This permission shall continue forever. I further grant HACK IT LLC (DBA Blurscape) all right , title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant HACK IT LLC (DBA Blurscape), the right to give, sell, transfer, and exhibit the print in copies of facsimiles thereof, for marketing, communications, or advertising, purposes, as it deems fit.
By entering HACK IT LLC (DBA Blurscape) premises, I hereby waive the right receive any payment for signing this release and waive and the right to receive any payment for HACK IT LLC (DBA Blurscape) for the use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied. I acknowledge that I have read the foregoing and I fully understand the contents. I also certify that in the event I am signing on behalf of a minor who is under the age of eighteen years, to whom this release applies and that I have the legal authority to execute this release, I approve the foregoing and agree that we shall be bound thereby.

ACKNOWLEDGMENT AND UNDERSTANDING:
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL THE PROVISIONS OF THIS RELEASE AGREEMENT AND AM FREELY, KNOWINGLY, AND VOLUNTARILY ENTERING INTO THIS AGREEMENT AND UNDERSTAND THAT I HAVE GIVEN UP CERTAIN LEGAL RIGHTS BY SIGNING IT.
A SIGNED RELEASE AGREEMENT IS REQUIRED FOR EACH PARTICIPANT.

Sign in to Google to save your progress. Learn more
Participant Name *
Date Of Birth *
MM
/
DD
/
YYYY
Emergency Phone Number *
By completing and submitting this form you agree to the terms and conditions regarding the Release Wavier. *
Required
Participant/Guardian Signature *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Blurscape. Report Abuse