Bumper Boats
Climbing Wall
Inflatables Fun Park
Go-Karts
Archery Tag

    Participant Name
    Date
    Participant Name
    Date
    Participant Name
    Date
    Participant Name
    Date

    In consideration of being allowed to participate in any way at Villa Roma Resort and related events and activities I the undersigned, acknowledge, appreciate, and agree to the following:
    1) The risk of injury from the activities involved in Bumper Boats / Climbing Wall / Inflatable Fun Park / Archery Tag & Go-Karts are significant, including the potential for permanent paralysis and death.
    2) I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Villa Roma Resort or others and Assume full responsibility for my participation. I confirm that I am physically and mentally capable of participating in Bumper Boats/Climbing Wall/Inflatable Fun Park/ Archery Tag & Go-Karts.
    3) I for myself and on behalf of my heirs, assigns ,personal representatives and next of kin, hereby release, indemnify, and hold harmless Villa Roma Resort, its officers, officials, agents, and/or employees, other participants, sponsors, advertisers and if applicable, owners and lessors of premises used for Bumper Boats/Climbing Wall/Inflatable Fun Park/ Archery Tag & Go-Karts (RELEASEES), FROM ANY AND ALL CLAIMS, DEMANDS, LOSSES, AND LIBABILITY ARISING OUT OF OR RELATED TO ANY INJURY, DISABILITY, OR DEATH I MAY SUFFER, or loss or damage to person or property. Whether arising from the negligence of the releasees if otherwise to the fullest extent permitted by law.
    4) I permit the use of any photos, slides, film, or sketches of me taken during the day's activity for publicity, advertising, promotions, or other commercial purposes.
    5) In consideration of using the facility PARTICIPANT CONTRACTUALLY AGREES that ALL claims for injury and/or death Shall be GOVERNED BY NEW YORK STATE LAW AND EXCLUSIVE JURISDICT1ON shall be in the District court resident where the allege incident occurred. (Sullivan County, NY)
    6) PARTICIPANTS GOING ON THE GO-KARTS MUST BE AT LEAST 56 INCHES IN HEIGHT AND AGE 10 AND UP FOR SINGLE RIDERS ONLY. MUST BE 18 YEARS OF AGE FOR DOUBLES.
    I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

    Signature
    Date
    Age
    Street
    City
    State
    Zip

    FOR PARENT/GUARDIANS OF PARTICIPANTS OF MINOR AGE: This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above all the Releasees, and for myself, my heirs, assign, and next of kin. I release and agree to indemnify Villa Roma Resort from any and all liability incidents to my minor child's participation with these activities as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES to the fullest extent permitted by law.

    Parent/Guardian Signature
    Date

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