IN CONSIDERATION of being permitted to participate in any way in any program, service (including but
not limited to food service), or activity offered by Old Town Athletic Club, LLC (“Company”) on or
about the premises located at 331 Walker Drive, Warrenton, VA 20186 or elsewhere under the
supervision of Old Town Athletic Club, LLC (collectively the “Premises” and collectivity, the “Activity”)
at any time EACH OF THE UNDERSIGNED, for himself/herself, his/her personal representatives, heirs,
successors, next of kin, and for the Minors (defined below) agrees (collectively, “I”, “My”, “They”,
“We”, “Us” or “Our”) that:
1. I will immediately inspect the Premises upon entering and warrant that our entry therein and/or the participation of
the minor(s) listed below (collectively, the “Minor(s)”) in the Activity constitutes an acknowledgement that I have inspected
the Premises and find it safe and reasonably suited for the purpose of its use. I agree that if at any time in the Premises I
believe something is unsafe, I will bring it to the attention of the Company, and will vacate the Premises with the Minor and
withdraw from participation in the Activity. I agree that either the undersigned parent and/or guardian or the designated
agent of the parent and/or guardian undersigned below (“Agent”) shall supervise the Minor at all times while on the
Premises and/or participating in the Activity. Further, the parent and/or guardian or Agent shall follow and cause the Minor
at all times while on or about the Premises and/or participating in an Activity, to follow all rules and policies of the
Company, as may be updated from time to time by the Company (“Rules”), whether the Rules are posted as safety signs
or posted as lists on the Premises, whether the Rules are communicated verbally, or whether the Rules
otherwise provided to Us. I agree that failure to follow and/or failure of the Minor to follow the Rules at all times may result
in Our expulsion from the Activity and/or Premises.
2. I HEREBY ASSUME ALL RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE TO Us due to participating
in Activity on the Premises HOWEVER CAUSED. I understand that use of the premises and involvement in Activities is inherently dangerous and I agree to assume all risks involved in participating in the Activities while in or upon the
Premises for any purpose and/or while participating in any way in the Activity. I recognize and understand that there are
risks and dangers associated with the Minor’s and/or our participation in the Activity, and that admission to Premises could
cause severe bodily injury, disability and death. Further, we understand that we assume all risks in participating in the
Activity and/or being admitted to the Premises no matter what the actual cause of the injury is. We assume all of the risks
and dangers associated with Minor’s participating in the Activity and/or entry into the Premises.
3. We RELEASE, waive, discharge, hold harmless, defend and covenant not to sue the Company, its parent
companies, subsidiaries, affiliated companies, joint ventures, business partners, licensors, employees, agents,
administrators, directors, officers, members, stockholders, volunteers, customers, officials, rescue personnel, sponsors,
customers, advertisers, and/or owners as well as the lessees and licensees of the Premises (each of the forgoing shall be
considered one of the “Releasees” herein) from all liability to Us (including but not limited to the Agent), Our personal
representatives, assigns, heirs, successors, and next of kin, for any and all claims, demands, losses or damages of the
Minor and/or Us on account of any injury, including but not limited to the death or injury of Us or the Minor or damage to
property, regardless of its cause.
4. We hereby agree to INDEMNIFY and save and hold harmless, the Releasees and each of the Releasees from any
loss, liability, dam- age, cost, or fees (including but not limited to attorney’s fees) thatdsf the Releasees may incur due, in
any manner or degree, to the presence of the parent/guardian or the Minor in the Premises, or related in any way to Our
participation in the Activity or presence. We further recognize and agree we are executing this Release, Waiver, Indemnity,
and Assumption of the Risk Agreement (this “Agreement”) on behalf of Us and on behalf of the Minor freely, voluntarily
and with full knowledge of the risks assumed.
5. We agree that photographs, pictures, slides, movies or videos of the Minor or of any of Us may be taken in
connection with the Minor’s or Our use of the Premises and/or participation in any Activity without compensation from the
Company or any person or entity (collectively, the “Media”) and We hereby grant to the Company a royalty-free, paid-up,
irrevocable, nonexclusive, perpetual, worldwide, license to (in any media now known or not currently known or invented)
reproduce, publish and display the Media for any purpose, including but not limited to commercial and non-commercial
purposes. We agree that the Releasees shall not be responsible for any personal property of ours which may be lost or
stolen while we are on the Premises and further agree that no bailment with respect to any of our personal property is
created with the Releasees.
6. We represent and warrant that the Minor and that we are in good health and have no physical condition that would
prevent the Minor or we from participation in the Activity or supervising such Activity to the level represented herein. We
represent and warrant that we are authorized to execute this Agreement in the capacity listed below.
7. This Agreement extends to all acts of negligence, gross negligence, recklessness, and intentional conduct by the
Releasees, including but not limited to rescue operations and is intended to be as broad and inclusive as is permitted by
Virginia law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in
full legal force and effect. This Agreement shall be construed in accordance with, and any and all disputes arising under or
out of this Agreement shall be governed by, the laws of the Commonwealth of Virginia without regard to principles of
conflict of laws.
8. It is the intention of the parties that the provisions of this Agreement shall be enforceable to the fullest extent
permissible under law. No covenant or provision shall be dependent upon any other covenant or provision unless so
expressed herein. In any event that any section of this Agreement or any provision of any such section, shall for any reason be held to be wholly invalid, illegal, or unenforceable, such invalidity, illegality, or unenforceability shall not affect
any other section hereof, or any other provision of any affected section, and this Agreement shall be construed as if, and
enforced as fully as if, such invalid, illegal, or unenforceable section or provision had never been contained herein.
9. RESTROOM RULES: Children must always be accompanied into the restrooms, no exceptions. This policy helps to
make sure children are washing their hands before returning to the playground, which helps us all stay healthy! It also
reduces the risk of clogged toilets, excessive soap usage and little “lakes” forming on the floor.
10. If the Minor is not FULLY potty trained, a pull up or diaper MUST be worn at all times. Any participant(s) not following
this rule will be asked to leave.
11. We are not responsible for any accidents involving trampolines.
12. We are not responsible for lost or stolen items.
13. No food or drink (except water) is allowed in the activity area at any time.
14. We can prohibit any action if we deem that it is against our policy.
15. Strollers are not allowed in the activity area.
16. No objects of any kind can be in the pockets or clothing of participants.
17. Shoes are NOT ALLOWED to be worn by participants at any time! Shoes and other items can be left in the cubbies
upstairs in the mezzanine.
Acknowledgment of Understanding: We have carefully read, understand and voluntarily sign this agreement and intend my/ OUR signature to be a complete release of all liability, including due to inherent risks or ordinary negligence by the company, to the greatest extent allowed by the laws of the state of Virginia. Further, We assert that We have explained the risks of the activity to mi- nor(s) and they understand this Agreement. WE UNDERSTAND THAT WE ARE GIVING UP SUBSTANTIAL RIGHTS, including our rights and the rights of the minor(s) to sue for damages in the event of death or injury to the minor(s) or to us.
I certify that I am AT LEAST 18 YEARS OLD AND the parent or legal guardian of the MINOR(S) listed and by my signature agree to be bound by the terms of this agreement.