Group Name (if applicable)
Select Group (If Applicable)
Alanna Strohecker
Bevin Dolan
Bevin Dolan
Colleen MacNamara
Jennifer Bachman
Karla Morgan
Maggi Iuliano
Patricia McShane
Sian Schafle
Susan Srogota
Aleah Develin
Ali Honish
Amanda Kelly
Amy Ferrell
Andrea Byrd
Angela Testa
Angie Price
Ann Houseman
Azuree Jones
bachrach
Bart Cobbs
Bergquist Party
Beth Dainoff
Beth Cooke
Betsie Drust
Brianna Markgraf
Bucci
Cait Marinello
Camp Lamb
Carin Brizzi
Cassandra Queen
Cedar Grove Camp
Charlene Iannella
Charmaine Bazemore
Christina Rideout
Christina Tarsiewicz
Clair Williams
cole
Colleen Michel
Cory Kacergis
Courtney Gilliam
Crystal Eickhoff
Dana McCarthy
Danielle Sibilla
Darryl Jones
David Secouler
Debbie Steffler
Deirdre Horan
Denise Cranata
Denise Piazza
DEttorre
Devon Graham
Diana Rodgers
Elaine Kim
Elizabeth Johnson
Emily Benek
Emily Gallo
Erica Wharton
Erika Benowitz
Erika Clark
Erin Kini
Gail Hoeflich
Gillman
Gino DeSantis
greeniche
Heather Fix
Jacki Garro
Jackie Weeks
Jaime Stewart
James Fraelich
Jamie Colcher
Jasmine Dobbs
Jen Manderachi
Jen Reiter
Jenn Tinker
Jennifer Tornetta
Jennifer Wong
Jerry Cipollini
jessica kopp
Jillian King
Joanna Oszeyczik
John Lembeck
Kalpana Kumar
Karyn Norton
Katerina Romano
Katie Dugan
Katie Kelly
Katie McCoy
Kelley Maddox
Kelli Williamson
Kelly Landis-Schuler
Kelly Panetta
Kelly Gallagher
Kelly Gallagher
Kelly Rittenhouse
Kerri Knoll
Kerry Scott
Kevin OToole
Kimberly Sally
Kimberly Petrucci
Kimberly Sally
Kira Thomas
Kohar Group
Latoya Coffee
Lau DeJoseph
Laura Caldwell
Laura DiCicco
Lauren Lulis
Leah Addis
Leah Chalwe
Lee Lee
Lindsey Brooks
Lisa Duke
Lisa Cifelli
Lisa Davis
Lisa McGarvey
Logan
Mackenzie Kochie
Maria Laffredo
Marino
Mark Young
Mary Kate Calcagni
Mary Sprandio
Marya Jordan
Marya Jordan
matt hand
Matthew Gravelle
Medlock Group
Megan Clifford
Megan Eckelmeyer
Megan Wuebber
Meghan Perkins
Meghan Sarli
Melanie Ferriola
Meredith Klein
Michele McNamee
Michelle Dickerson
Monique Lewis
Nakeshia Goodman
Nakia Pittman
nancy park
Nancy Park
Natalie Bucci
Natasha Buhariwalla
Natasha Lamb
Nicole Kindred
Nicole Ruck
Nneka Mosley
Patrick Conlogue
Pina Forr
pizek
Rachel Gretchen
Ray Brittingham
Reagan Jones
Rebecca Courtney
Rennie Volpe
Rhiannon Serpico
Robyn Henry
Rory Rebuck
Ross Popko
Roz Talley
Ryan Heickert
Sabrina Lear
Sean Lonergan
shannon
Shannon Hitchcock
Shannon Myers
Sharri Pressman
Sophia Hoepfl
Stacey Dinnell
Stecher Party
Stephanie Poper
Stephanie Sinno
Steve Kammerer
Steven Cronin
Steven McCarthy
Steven Sommers
Sudan Khan
Susan Saurman
Susan Tiaru
Tamika Duckett
Tatyana Semenoff
Tiffany Viola
Tim Fleming
Tracey Weibrecht
Vanessa Robinson
Vishal Gosnami
Wendy Schultz
Whitney Bachrach
Name of Adult - Must be at least 18 years of age
Contact Information
Address
DOB
Drivers License
DL State
How many children do you need to add to this waiver?
None
1 child
2 children
3 children
4 children
5 children
6 children
7 children
8 children
Waiver
" A COMPLETED RELEASE AND WAIVER IS REQUIRED IN ORDER TO PARTICIPATE AT BOUNCETOWN. We will not allow participants without a signed waiver. Feel free to contact switch any questions or concerns. In consideration of being able to participate in various activities at BOUNCETOWN, INC. facility, the undersigned, on his or her own behalf, and on behalf of any executors, heirs, successors, and assigns hereby acknowledges and agrees as follows: The undersigned knowingly and fully assumes all risks, known and unknown, associated with participants in activities at BOUNCETOWN, INC. and waivers all claims for damage to person or property arising from such participation. This release and waiver covers any and all risks of death, serious injury and property loss whether arising from (i) negligence or carelessness on the part of the persons or entities being released and other participants, and/or (ii) dangerous or defective equipment. 2. The undersigned certifies that he or she has read this agreement, understands it and signs it voluntarily as his/her own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. The undersigned further certifies that he/she is at least eighteen (18) years of age and fully competent and executes this agreement for full, adequate and complete consideration fully intending to be bound by same. The undersigned further certifies that he/she is physically fit and may participate in the activities available at BOUNCETOWN, INC. and has not been advised otherwise by a qualified medial person; 3. The undersigned on his or her behalf and on behalf of any executors, heirs, successors and assigns hereby agrees to release, waive, discharge, covenant not to sue, indemnify, save and hold harmless any authorized entity doing business as BOUNCETOWN, INC. (the “Companyâ€) and its directors, officers, agents, employees, representatives, and all affiliates, successors and assigns, from and against any and all suits, claims, demand, costs, fees, damages, losses, judgements, fines, amounts paid in settlement and other liabilities and expenses including but not limited to, actual damages, compensatory damages, punitive damages, fines, and legal fees arising from death, disability, personal injury, property damage or theft, or actions of any kind: 4. The undersigned agrees to comply with the rules and conditions of participation expressed or posted at BOUNCETOWN, INC. If the undersigned observes any significant hazard during such participation, the undersigned will promptly inform an employee of BOUNCETOWN, INC. and 5. The undersigned acknowledges that this release and waiver of liability form will be used and relied upon by the Company and that it will govern the undersigned’s actions and rights. 6. I understand that entry, by myself and the participant(s) named, constitutes consent for Bouncetown to use any film, video, or likeness of participants for any purpose whatsoever, without payment to the participant. "
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT AND SUBMITTING THIS FORM, AND I AM SIGNING IT AND SUBMITTING THIS FORM FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
IP: 18.191.174.168
Sign On the Line Below:
Save
Clear Signature