ABC Tree Farms LLC • ABC Seasonal Specialty Supply, LLC • Pick of the Patch Pumpkins
Acknowledgement of Risks, Assumption of Risks, & Responsibility of Liability for Organizations and Individuals
WARNING: There are significant elements of risk in any adventure, sports or activity associated with the indoor or outdoor use of games and activities incidental thereto (referred to as “activity”). Although we have taken reasonable steps to provide you with the appropriate equipment and/or skilled staff, this activity is not without risk. Certain risks cannot be eliminated without destroying the unique character of the activity. For your safety, and that of the other participants, we think it is important for you to know in advance what is to be expected and to be informed of the inherent risks. I further understand and agree to comply with the following rules:
- All participating children must ride individually – one at a time.
- Parents are NOT allowed on the inflatable amusements at any time. Children may not ride on anyone else’s laps.
- No jumps, no flips, no pushing, no fighting and/or rough housing on the games/inflatables.
- If I break any of the rules the attendant has the right to remove me from the game/inflatable/rides and cease my participation in the game/inflatable/rides.
ACKNOWLEDGEMENT OF RISK: I acknowledge that the following describes some BUT NOT ALL, of those risks: risks of personal injury, accidents and/or illness including but not limited to sprains, torn muscles and/or ligaments, fractured or broken bones, eye damage, cuts, wounds, scrapes, abrasions and/or contusions, dehydration, oxygen shortage (anoxia), and/or exposure, head, neck, and/or spine injuries, allergic reaction, shock, paralysis or death. I/we understand the description of these risks. I/we elect to participate in spite of the risks. I/we agree to assume responsibility for the risks identified herein and those risks not specifically identified. My/our participation in these activities is purely voluntary. No one is forcing me/us to participate. I/we verify that I/we are physically fit, not under the influence of alcohol or drugs at this time, and sufficiently qualified and trained capable to participate in these activities. I/we elect to participate in spite of the risks.
COVID-19: I voluntarily seek services provided by ABC Tree Farms LLC and acknowledge that I am increasing my risk to exposure to COVID-19. I attest that: *I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. *I have not traveled internationally within the last 14 days. *I have not traveled to a highly impacted area within the United States of America in the last 14 days. *I do not believe I have been exposed to someone with a suspected and/or confirmed case of COVID-19. *I have not been diagnosed with COVID-19 and not yet cleared as non-contagious by state or local public health authorities. *I am following all CDC recommended guidelines as much as possible and limiting my exposure to COVID-19.
AUTHORIZATION AND RELEASE: In consideration of services or property provided, I for myself and/or minor children for which I am parent, legal guardian, group leader, or otherwise responsible, any heirs, personal representatives or assigns, agree that J. R. Klima Jr. individually and ABC Tree Farms, LLC, ABC Seasonal Specialty Supply, LLC, their principles, directors, officers, agents, employees and volunteers, their insures and each and every land owner, landlords’, municipal and/or governmental agency upon those property an activity is conducted and their insures, if any, shall have no liability except for its sole negligence. I/we hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the activity. These events are being filmed and photographed. Your entry beyond this point constitutes your consent to be filmed and/or photographed and your likeness to be reproduced in productions relating to ABC Tree Farms, LLC & Pick of the Patch Pumpkins in perpetuity. I hereby release and agree to hold ABC Tree Farms LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act, or that may otherwise arise in any way in connection with any services received from ABC Tree Farms LLC. I understand that this release discharges ABC Tree Farms LLC from any liability or claim that I, my heirs, or any personal representatives may have with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ABC Tree Farms LLC. This liability waiver and release extends to all owners, partners, and employees.
Please complete all entries above before proceeding to payment.