Registration and Liability Waiver

VERSION FRANÇAISE

Please complete a waiver per address. All participants must reside at the same address.

Participant 1
Name*
First Name Name
Date of Birth*

YYYY
MM
DD
Email*
Physical condition 1
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Participant 2
Add another participant
Participant 2
Name
First name Name
Date of birth

YYYY
MM
DD
Email
Physical condition
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Participant 3
Add another participant
Participant 3
Name
First Name Name
Date of birth

YYYY
MM
DD
Email
Physical condition
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Participant 4
Add another participant
Participant 4
Name
First Name Name
Date of birth

YYYY
MM
DD
Email
Physical condition
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Participant 5
Add another participant
Participant 5
Name
First Name Name
Date of birth

YYYY
MM
DD
Email
Physical condition
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Participant 6
Add another participant
Participant 6
Name
First Name Name
Date of birth

YYYY
MM
DD
Physical condition
If the answer is YES to a question, check the box.
- Are you pregnant?
- Do you suffer from vertigo?
- Do you have heart problems?
- Have you ever had a concussion?
- Do you have physical disorders?
- Other
Please specify the "other" physical condition
Email
Address
Address*
Province / State Postal / Zip Code Country
Person to contact in case of emergency
Name (Emergency)*
Phone Number (Emergency)*
Questions
Promotions and rebates
I want to receive via email rebates, promotions and other information related to Aquazilla.
How did you hear about us?
- Facebook and Social Networks
- Word of mouth
- Passing nearby
- Billboard or in the subway
- Television
- Radio
- Magazine, Newspaper
- Search on the Internet
Please check all that apply
DId you plan on coming to Aquazilla today?
- Yes
- No
Did you come by car
- Yes
- No
Liability Release
I, the undersigned, recognize and agree to the terms listed below:

Any activity at Aquazilla including aerial courses, climbing, tube sledding, inflatable games, escape missions, multimedia theater, archery tag and events as well as the use of the related equipment (hereinafter “Activities”) entails considerable elements of risk.

I confirm that I am in good physical health and that I have no health problems that stop me from participating in Aquazilla’ Activities. I acknowledge that if I answered yes to any question regarding my physical condition, I should not take part in the Activities.

I acknowledge that I have been informed and that I am aware of the risks and dangers associated with the Activities. These risks include, but are not limited to: (1) performing demanding physical effort; (2) falling or colliding with the games, the equipment, the ground or other participants; (3) mechanical defects or improper use of any piece of equipment. In addition, I have been informed, I am aware and I accept the risks that the Activities may cause, such as the loss or damage of your belongings, an accidental injury, or in extreme cases, permanent trauma or death.

For the safety of everyone, I acknowledge and commit to respect the rules and regulations of Aquazilla, a copy of which is displayed at the service kiosk, and to follow all of the orders and instructions given by the employees of Aquazilla.

In addition, I take the responsibility to assume the cost to repair or replace borrowed equipment in the case of breakage or loss.

I authorize Aquazilla to use, for advertising ends, all representations in the form of video or photographical images in which I may appear.

I acknowledge and agree to assume all of the risks associated with participation at Aquazilla and to release Aquazilla, its directors, employees, participants, owners and representatives from all responsibility, loss, damages, judgments, claims or proceedings of any kind, whether or not the fault is a result of the negligence of Aquazilla.

I acknowledge that I have read and understood all the measures and procedures put in place by the company to reduce and control the risk of COVID-19 infection. I understand that these are mandatory and that I must comply with them.

I also understand that in order to protect the health, safety and physical integrity of its customers and employees, the company must ensure that the measures in place are applied and that it must intervene in the event of a defect.

I acknowledge that I have read, understood and accepted all of the terms and conditions set forth in the current liability release and assumption of risks and that I am participating in the Activities of my own free will, without any other influences.
Signature for participants, parents or tutors*
* I acknowledge that I am in a position of authority over the child of less than 16 years of age that I am signing for (hereinafter “Child”) and that: (i) I am the parent/guardian of the Child; or (ii) I have custody of the Child and I have obtained the parents’/guardians’ consent to participate in Aquazilla and to sign the current release and its conditions in their name and in the Child’s name.
Date
MM slash DD slash YYYY

La décharge est valide pour une période de douze (12) mois suivant la signature.
Signature – Participant 1*
Signature – Participant 2
Signature – Participant 3
Signature – Participant 4
Signature – Participant 5
Signature – Participant 6

VERSION FRANÇAISE

REGISTRATION AND LIABILITY WAIVER

Participant 1

Participant 2

Participant 3

Participant 4

Participant 5

Participant 6

Address

Person to contact in case of emergency

Questions

Liability Release

Signature for participants, parents or tutors*