Barkum Art of Fun Waiver Form

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS BARKUM ART OF FUN visit, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the BARKUM ART OF FUN- JACKSONVILLE or directors, officers, managing members, employees, volunteers, representatives, and agents of BARKUM ART OF FUN- JACKSONVILLE being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I understand this activity has potential risks including but not limited to:

1) Use of Acrylic and other types of home paints that may or may not consist of Lead based paint; 2)Potentially moving or lifting objects of not more than ten pounds; 3)Mental and physical stress and anxiety; 4)Being in a reasonably small space with strangers and other groups unless booking a private space; 5)Possibility of failure to create at BARKUM ART OF FUN as desired; 6) Exposure to paint splatter by the nearby patrons in the same room while splattering paint; 7) Potential dizziness due the nature of black lights and glow in the dark effect; may not be recommended for seizure prone individuals;

I have no physical or mental illness that precludes my participation in a safe manner for myself or others. I am not under the influence of drugs which impairs my ability to maintain my safety awareness or endangers others.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by BARKUM ART OF FUN- JACKSONVILLE of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. I agree that all staff or authorized agents may, in their sole discretion, determine it is unsafe for myself or others for my participation to continue, ask the individual/party to leave the premises.

I hereby grant permission to BARKUM ART OF FUN- JACKSONVILLE and its representatives to take photographs or videos of me and to make recordings at the event or the location 7035 Philips Hwy #9 JACKSONVILLE, FL 32216.

I further grant to the producers and their representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of their images and recordings in any media now known or later developed.

I acknowledge that BARKUM ART OF FUN- JACKSONVILLE owns all rights to the images and recordings.

I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy.

I further waive all moral right. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials.

I hereby release, defend, indemnify and hold harmless the producers from and against any claims, damages, or liability arising from or related to the use of the images recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use incomposite from that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I am 18 years of age or older and I am competent to contract in my own name.

I have read this document before signing below, and I fully understand the content, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property and clothing damage, property theft, or actions of any kind which may hereafter occur to me,

THE FOLLOWING ENTITIES OR PERSONS: The directors, officers, managing members, employees, volunteers, representatives, and agents of BARKUM ART OF FUN- JACKSONVILLE and ; insurers, and affiliated organizations

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE BARKUM ART OF FUN- JACKSONVILLE or directors, officers, managing members, employees, volunteers, representatives, and agents of BARKUM ART OF FUN- JACKSONVILLE from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that the directors, officers, managing members, employees, volunteers, representatives, and agents of any authorizing entity are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose this authorizing entity decides, and assigns including marketing.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. (Form fields with * are required.)

I Agree

By hitting accept, 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 which is available at our location. By hitting accept, 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 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.