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Laser Tag Participant Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement EACH INDIVIDUAL MUST

READ AND SIGN THIS RELEASE OF LIABILITY AND CONSENT FORM, FOR RISK OF INJURY AND/OR USE OF PHOTO/VIDEO IMAGES IN ORDER TO PARTICIPATE IN ANY LASER TAG ACTIVITY. THIS FORM MUST BE SIGNED AND READ BEFORE THE PARTICIAPNT IS ALLOWED TO TAKE PART IN ANY LASER TAG ACTIVITIVES. Participant Name _________________ Date of Birth _____________________ In consideration for being permitted to participate in any way in the sport and activities of World Extreme, I the undersigned agree and acknowledge that: • I fully understand that Laser Tag involves risk of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my actions/inactions or those of others participating in laser tag. • I fully understand that there may be other risks, either known or not known to me, or not readily foreseeable at this time, and I fully accept and assume all such risks and all responsibility of losses, costs and damages I incur as a result of my participation. • I agree to fully comply with al rules, regulations and policies during my participation and understand World Extreme reserves the right to remove me for failing to comply with any instruction. • I hereby grant Management reproduction rights to use my name and likeness in any media, including the internet, for any purpose without further compensation or notice to me. • I understand that there may be photos or video taken of me and that these images may be used for advertising by World Extreme. I approve and give full consent to such use of my image. • I for myself and on behalf of my heirs, assigns, personal representatives and next of kin hereby release and hold harmless World Extreme, their officers, officials, agents, employees and the property owners from any and all liability for injury, disability, death, loss of damage to personal property. • I acknowledge, understand, and agree that I have read this release of liability and assume all risk associated with participating and that I sign this release of liability voluntarily and knowingly, without inducement of any kind. I hereby release, discharge, and covenant not to sue World Extreme, or the property owners or lessees, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers (each considered one of the “RELEASES” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence or “Releases” or otherwise, including negligent rescue

operations; and I further agree that if, despite the release, waiver of reliability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save and hold harmless each of the releases from any loss, liability, damage, or cost which any may incur as a result of such claim. ****DANGER**** LASERTAG IS EXTREMELY DANGEROUS. LASERTAG IS NOT DESIGNED TO BE SAFE. DANGERS INCLUDE BUT ARE NOT LIMITED TO TRIPPING, FALLING, COLLISIONS WITH PERMANENT STRUCTURES AND OTHER PARTICIPANTS, SHARP OBJECTS AND LOUD NOISES ****DANGER**** _____________________________________________ Laser Tagger’s Name (printed) _____________________________________________ Date of Signature _____________________________________________ Signature _____________________________________________ Email (optional) PARENTAL CONSENT (Required for participants under the age of 18) …AND, I, the minor’s parent and or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, and covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releases from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the releases or otherwise, including negligent rescue operations, and further agree that it, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Release may incur as the result of any such claim. _____________________________________________ Name of Parent or Guardian (printed) _____________________________________________ Date of Signature _____________________________________________ Signature _____________________________________________ Emergency Contact Phone Number