Hustonville Haunted Asylum / Panic Room

RELEASE OF LIABILATY, AGREEMENT TO WAIVE CLAIMS, EXPRESS

ASSUMPTION OF RISKS, AND INDEMNITY AGREEMENT

(Read the following and be certain you understand the implications of signing)

By signing this document I understand that I waive certain legal rights, including the right to sue.

EXPRESS ASSUMPTION OF THE RISKS ASSOCIATED WITH PARTICIPATING IN

THE HUSTONVILLE HAUNTED Asylum/PANIC ROOM.

 

I, ____________________________ do hereby affirm and acknowledge that I have been informed of inherent hazards and risks associated with the Hustonville Haunted Asylum and The Panic Room. I fully understand that these risks can lead to severe injury and even death. Despite the potential hazards and dangers associated with Hustonville Haunted Asylum and the Panic Room I wish to proceed and I freely accept and expressly assume all risks, dangers, and hazards that may arise from the Panic Room and could result in personal injury, death and property damage to myself or others. I understand that a repeated or flagrant violation of any rules while in the Panic Room or other wise during any participation may result in my ejection from the Panic Room with NO rebate of the fee.

RELEASE OF LIABILITY, AGREEMENT TO WAIVE CLAIMS, EXPRESS

ASSUMPTION OF RISKS, AND INDEMNITY AGREEMENT

In consideration of being allowed to participate in the Panic Room as well as the use of any of the facilities and use of the equipment, props etc of a releasee, I hereby agree as follows:

1. TO WAIVE AND RELEASE ANY AND LL CLAIMS, DIRECT OR INDIRECT,

that I may have in the future against any of the following named persons or entities (hereinafter referred to as Releasees):

HUSTONVILLE HAUNTED Asylum/PANIC ROOM, FRED MCCOY, his helpers, assistants, volunteers or anyone at the Hustonville Haunted Asylum/Panic Room, located at 41 College St. in Hustonville, Ky..

2. To release the releasees, their officers, directors, employees, representatives, agents and volunteers, from all liability and responsibility, whatsoever, for any claim or cause of action that I, my estate, heirs, executors or assigns may have for personal injury, property damage or wrongful death arising from participating in the Panic Room. By executing this document, I agree to not to hold the releasees for any injury or death which may occur to me while participating in the Panic Room/Hustonville Haunted Asylum.

3. By entering into the Agreement, I am not relying on any oral or written representations or statements made by the Releasees, other than what is set forth in this Agreement. I further agree that this Agreement shall be governed by and interpreted in accordance with the laws of the Commonwealth of Kentucky, United States of America.

PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING. IF YOU HAVE ANY QUESTIONS PLEASE ASK US OR CONSULT AN ATTORNEY

The Panic Room/Hustonville Haunted Castle, it’s agents, employees, members, and volunteers, (hereinafter Panic Room/Hustonville Haunted Asylum) have done everything possible to assure that our guests experience a rewarding experience. We wish to inform our guests that the Panic Room is not risk free. The same elements that contribute to the unique character and fun of the Panic Room such as the physical exertion, eating or drinking can cause sickness, naseness , injury illness, or in extreme cases, permanent trauma or death. We do not want to heighten or reduce you enthusiasm for the experience, but we do want you to know in advance what to expect, and to be informed of some of the possible risks. We ask that you read this, sign it, and return it to the person in charge of the Panic Room.

ACKNOWLEDGMENT OF RISK

Panic Room like all stunts can be hazardous. It is also possible that some participants would suffer mental anguish or trauma from the experience or their injuries. This list is not exclusive or exhaustive list of possible injuries, trauma or accidents that may occur while in the Panic Room. Most of these injuries are rare and you are not likely to encounter them. However, they have occurred and you need to know about them and other possible injuries not mentioned above. I am not using drugs or alcohol; I’m physically able to undertake the activities. I am fully capable of participating in the Panic Room. I state that I have read this statement on some of the possible risks in this activity. Therefore, I assume full responsibility for myself, for bodily injury, death and loss of personal property and any expenses as a result of my negligence, or the negligence of the Panic Room, I also understand that the Panic Room/Hustonville Haunted Castle reserves the right to refuse any person it judges to be incapable of meeting the rigors and requirements of participating in the Panic Room. I’m in good physical condition and able to undertake this activity.

CONTRACT, WAIVER, RELEASE AND INDEMNIFICATIONN

I agree to indemnify and hold harmless Hustonville Haunted Asylum/Panic Room, their agents and employees from all claims, damages, losses, injuries, and expenses arising out of or resulting from participation in these activities. I further agree to release, acquit and covenant not to sue Panic Room/Hustonville Haunted Asylum, their agents and employees for all actions causes of action claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of Panic Room/Hustonville Haunted Asylum or my family, myself, or my heirs, against Hustonville Haunted Asylum/Panic Room arising out of participation in this stunt. In short, I can not sue the Panic Room/Hustonville Haunted Asylum and if I do, I cannot collect any money.

I agree to the site of any lawsuit and the law governing any such lawsuit shall be in Kentucky and governed by Kentucky law. The terms of this agreement shall continue and be in effect after the Panic Room has ended.

As liquidated damages, I hereby agree that Hustonville Haunted Asylum/Panic Room is forced to defend any action, lawsuit or litigation by myself, my executors, or my heirs, on my family’s or my behalf, my heirs or executors and I agree to pay Panic Room/Hustonville Haunted Asylum costs and attorney fees if they successfully defend such action, lawsuit or litigation. Should a court of competent jurisdiction declare any paragraph or part of this agreement unenforceable, the remaining parts or paragraphs shall remain in full force and effect. I acknowledge that no guarantees have been made with respect to achieving objectives.

I authorize and release to Panic Room/Hustonville Haunted Asylum the use of my image in any photograph or video recording for any purpose of Panic Room/Hustonville Haunted Asylum.

I hereby declare that I am 18 years of age or above and am competent to sign this Agreement.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

SIGNATURE OF APPLICAT __________________________________ DATE ______________

SIGNATURE OF WITNESS ___________________________________ DATE______________

 

I, __________________________, of my own free will, my heirs and executors and myself, have read, understand and acknowledge the risks and liability for myself.

A copy of this release can be used as if it was an original.

I DO NOT have any medical conditions that would prevent me from participating in this activity.

ADDRESS: _______________________________________________________________________________

PHONE: (___)_________

IN CASE OF EMERGENCY PLEASE CONTACT: ___________________________________

PHONE: (___)_____________

NAME:___________________________________________

Are you allergic to any food products, sea food, milk products.

Note: This form must be read and the personal data provided before the participant is allowed to take part in any activities. By signing this form, the participant affirms having read it.

 

I recognize that there are dangers and risks to which I may be exposed by participating in.

 

The following is a description and examples of specific, significant, non-obvious dangers and risks associated with this activity.

I understand I will be eating, drinking, and performing a task. In order to compete in the Panic Room I understand I may be ask to eat fish worms, night crawlers, mill worms, sea food, cheese products, pork products etc.
In consideration of my involvement under the auspices of this sponsoring organization, I acknowledge and agree to assume and take on myself all of the risks and responsibilities in any way associated with this activity. ( I am taking part in this stunt at my own risk).

I have read and understand the above Release and Waiver and sign it voluntarily.

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Participant’s Signature ________________                                Date ________