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

    Escape 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.
The individual named below (referred to as “I” or “me” and includes children and wards) desires to participate in any and all activities, including, but not limited to, climbing, jumping, using electronic equipment, furniture, locking mechanisms, receiving instruction, engaging in strenuous bodily movement, being confined to an enclosed space, and any similar activities (the “Activity” or “Activities”) provided at B21 Escapes by The Works at Wyomissing, LLC , a Pennsylvania limited liability company with offices located at 1109 Bern Road, Wyomissing, PA 19610 (the “Company”). As lawful consideration for being permitted by the Company to participate in the Activity, I agree to all the terms and conditions set forth in this agreement (this “Agreement”). I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES ARE DANGEROUS ACTIVITIES AND INVOLVE THE RISK OF SERIOUS INJURY, DEATH, AND/OR PROPERTY DAMAGE. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY BE COMPOUNDED BY NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DEATH, OR PROPERTY DAMAGE, WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR OTHERWISE. I hereby expressly waive and release any and all claims, now known or hereafter known in any jurisdiction throughout the world, against the Company, and its officers, directors, employees, agents, affiliates, shareholders, members, successors and assigns (collectively, “Releasees”), on account of injury, death, or property damage arising out of or attributable to my participation in the Activities, whether arising out of the negligence of the Company or any Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims. I acknowledge that this Agreement includes, without limitation, injuries, or accidents, emotional or physical, which may occur as a result of the use or misuse of the facility in any way by anyone, use of any equipment that malfunctions or breaks, improper maintenance of the facility, grounds, or any equipment, instruction or supervision, confinement to enclosed spaces, or slipping, tripping and/or falling while in the facility or on the surrounding premises. I agree to pay for all damages to the facilities of the Company caused by my negligent, reckless, or willful conduct. I agree to observe and obey all posted rules and warnings, and to follow any oral instructions or directions given by the Company and all other Releasees. I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out of or resulting from any claim of a third party related to the Activities. This Agreement constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the Commonwealth of Pennsylvania without giving effect to any choice or conflict of law provision or rule (whether of the Commonwealth of Pennsylvania or any other jurisdiction). Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Berks County, Pennsylvania and I hereby consent to the exclusive jurisdiction of such courts. BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.
  I acknowledge I have read and understand this waiver and certify that all personal information is correct.
  I wish to allow my email to be used for marketing purpose.
By signing this waiver, I agree that all information is complete and accurate.