ESCUETA, DAVID ANTONIO A.
/11480653
OMORFOS CHELONA FUN PARK
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
I HEREBY ASSUME ALL THE RISKS OF PARTICIPATING IN ANY/ALL
ACTIVITIES ASSOCIATED WITH OMORFOS CHELONA FUN PARK, that is
owned and controlled by CHELONA & SONS INC.
I HEREBY CERTIFY that I am physically fit and able to participate in any of the park’s
activities. I have not been advised by a qualified medical professional not to participate in
any strenuous activity. I certify that there are no health-related reasons or problems that
precludes me from participating in any kind of activity. I acknowledge that signing this
document prevents me from making any type of legal claim against OMORFOS
CHELONA FUN PARK/CHELONA & SONS INC. I know that doing bungee jumping
is a strenuous and dangerous activity and by its nature, despite exercising utmost care on
the part of the owners, directors, officers and employees of OMORFOS CHELONA FUN
PARK/CHELONA & SONS INC., there is that chance for to sustain an injury. Despite
this, I voluntarily request that I be allowed to experience doing bungee jumping at
OMORFOS CHELONA FUN PARK.
I hereby take full responsibility and acknowledge the following:
(1) I HEREBY WAIVE, RELEASE, AND DISCHARGE OMORFOS CHELONA FUN
PARK/CHELONA & SONS INC., and/or its directors, officers, employees, volunteers,
representatives, and agents, and the activity holders, sponsors, and volunteers from any and
all forms of liability for my death, accident, disability, personal injury, property damage,
property theft, property loss, or actions of any kind which may hereafter occur to me
including my traveling to and from this activity;
(2) I WILL NOT SUE OMORFOS CHELONA FUN PARK/CHELONA & SONS INC.
FOR INDEMNIFICATION or OTHER FORMS of liabilities or claims that may arise as a
result of my participation in this activity. I acknowledge that OMORFOS CHELONA
FUN PARK/CHELONA & SONS INC. is NOT responsible for the errors, omissions,
acts, or failures to act of any party or entity conducting a specific activity on their behalf.
(3) I HEREBY CONSENT to receive medical treatment, if deemed advisable in the event
of injury, accident, and/or illness during performance of the activity. I FURTHER
CONSENT to the taking of any photograph, video, or the like of me which could be used
for any legitimate purpose by the OMORFOS CHELONA FUN PARK/CHELONA &
SONS INC.
I HEREBY CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY
UNDERSTOOD ITS CONTENTS. I AM AWARE THAT THIS IS A LEGAL
DOCUMENT, WHICH I VOLUNTARILY SIGNED OUT OF MY OWN FREE WILL.
PARTICIPANT’S NAME/AGE SIGNATURE DATE:
JUNJUN JACINTO/29 ____________ ______
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