Before You Pick Up A Controller

Participation Waiver

Every guest — kid or adult — needs a signed waiver on file before entering the eGame Room. One form covers everyone in your party.

Parent / Guardian
Mailing address
Guest of Honor

Including the Guest of Honor. Max 50.

Additional info
Release of Liability, Waiver, and Assumption of Risks

The undersigned individual desires to participate in gaming, party, and recreational activities at premises owned and/or operated by Westchester Game Zone* (collectively and/or individually, the “WGZ”, “Facilities”, “WGZ and Facilities”). In consideration for the WGZ permitting me to use the premises including the gaming consoles, virtual-reality rigs, arcade machines, trampoline area, Nerf arena, basketball court, party rooms, and other equipment located indoors or outdoors, as well as participation in tournaments, camps, and private events, I have agreed to execute this Release of Liability and Assumption of Risks (the “Release”).

I hereby acknowledge and accept and agree THAT GAMING, PARTY, TRAMPOLINE, BASKETBALL, NERF, AND ARCADE ACTIVITIES AT OR ORGANIZED BY THE WGZ INVOLVE INHERENT RISKS. I received full information regarding the use of the Facilities and had the opportunity to ask any questions that I wished. Further, I have had the opportunity to examine the Facilities and have full knowledge of the nature and extent of all the risks associated with these activities and the use of the Facilities including, but not limited to:

a. Falls, trips, and impact injuries while moving around the Facilities, including collisions with walls, equipment, furniture, or other guests in the gaming room, trampoline area, basketball court, or Nerf arena;

b. Strains, sprains, and repetitive-motion injuries arising from extended controller use, virtual-reality play, or active-game participation;

c. Injuries resulting from the actions or omissions of others including, but not limited to, thrown Nerf darts, basketball collisions, dropped controllers or gaming hardware, or other personal effects;

d. Cuts, abrasions, and contact injuries resulting from skin contact with arcade cabinets, gaming hardware, trampoline frames, or any other facility surface;

e. Failure or misuse of game controllers, virtual-reality headsets, trampoline equipment, basketball gear, Nerf gear, or any other facility hardware;

f. Failure to follow the WGZ’ staff instructions or failure to ask for information or assistance;

g. Participation in age-restricted or skill-restricted activities (such as trampoline, Nerf, or basketball play) without staff clearance or appropriate supervision;

h. Eye strain, photosensitive reactions, motion sickness, or other discomfort arising from extended screen or virtual-reality exposure.

I further acknowledge that the above list is not a comprehensive recitation of all possible risks associated with the use of the Facilities and I agree that such list in no way limits the extent or reach of this Release of Liability Waiver and Assumption of Risks form. If, while using the Facilities, I see or hear anything that I feel is questionable or dangerous, it is my responsibility to inform a WGZ’ staff member and follow appropriate procedures and instructions thereby given.

I expressly agree and hereby promise to accept and assume all the risks associated with gaming, party, trampoline, basketball, Nerf, and arcade activities at the Facilities, both known and unknown. My participation in these activities is purely voluntary: I elect to participate in spite of the risks.

I hereby acknowledge that the WGZ provides orientation and/or instruction before use of the Facilities to all visitors. The WGZ also provides users with the option to inspect the premises and related equipment before choosing to use them. Certain activities (such as trampoline, Nerf, or basketball play) may require additional staff clearance or age-appropriate supervision. I understand that if I need additional assistance, orientation, instruction, or supervision during my participation at the Facilities at any future time, it is my responsibility to seek such assistance from WGZ’ staff prior to participating in any activity for which I am not qualified. Gear provided by the WGZ, if any, is intended to protect individuals from harm or negligence that may result from, but is not limited to, use of the Facilities. I agree that I have a duty to inspect and exercise good judgment and act in a responsible manner while using the Facilities or participating in any other related activity, and to obey all oral and written instructions and warnings prior to or during use. I agree that I have a duty to refrain from using the Facilities or participating in any other related activity when under the influence of drugs and/or alcohol. I further agree that I am responsible for paying the appropriate rate in exchange for the use of the Facilities. My signature below indicates that the WGZ’ staff has presented this information to me and I fully understand this information.

I, on behalf of myself, my spouse, children, heirs, administrators and assigns, also agree to release and discharge the WGZ and all and each of the WGZ’ employees, agents and representatives, as well as all other persons, corporations, or other entities that might have any liability to me (the “Released Parties”), from and against any and all damages, actions, claims and liabilities, whether known or unknown, anticipated or unanticipated, suspected or unsuspected, relating to or arising from any activity, occurrence, or event involving the Facilities or caused by the passive or active negligence of the Released Parties. This Release is intended to release and discharge the Released Parties from all damages, actions, claims and liabilities of any nature, specifically including, but not limited to, damages, actions, claims and liabilities arising from or related to the negligence of the Released Parties. I further agree to indemnify, hold harmless, and defend the WGZ from and against any loss, damage, liability and expense, including costs and attorneys’ fees, incurred by the WGZ as a result of my using the Facilities or participating in any activity sponsored by or involving the WGZ.

The duration of this agreement shall continue until it is cancelled or modified by written agreement. The laws of the State of New York shall govern the rights and obligations of the parties to this Release and the interpretation, construction, and enforceability thereof. I agree that any lawsuit brought against any Released Parties shall be brought solely in the New York State Supreme Court. The WGZ reserves the right to use any photograph or video recording taken at the Facilities, during a birthday party, private group, tournament, camp, or other event, in the WGZ’ promotional materials, brochures, social media, and website.

I HEREBY VOLUNTARILY WAIVE ANY RIGHT I MAY HAVE TO A TRIAL BY JURY IN ANY ACTION, PROCEEDING, OR LITIGATION INVOLVING ANY RELEASED PARTY.

THIS RELEASE IS A BINDING LEGAL CONTRACT. PLEASE READ IT CAREFULLY BEFORE SIGNING. I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.

*The Westchester Gym facilities and/or its subsidiaries include Fitness by Lifestyle TWG, LLC d/b/a The Westchester Gym.


Parental / Guardian Consent

As legal guardian of my designated guest(s) (guest(s)), I hereby consent to all guest(s) participating in this facility’s program(s). I recognize that potentially severe injuries can occur in any activity involving height, motion, or physical exertion, including, but not limited to, video gaming, virtual reality, arcade play, trampoline, Nerf, basketball, party games, tournaments, camps, and physical activity in general. I understand that it is the express intent of all staff and personnel to provide for the safety and protection of my guest(s) and, in consideration for allowing my guest(s) to use these facilities, I hereby COVENANT NOT TO SUE and FOREVER RELEASE this facility, affiliated and partner companies and organizations, property owners and lessors, staff, contractors, subcontractors, hosts, coaches, owners, directors and other members involved in this facility’s program(s), from all liability and for any and all damages and injuries suffered by my guest(s) during instruction, supervision, and/or control during any and all parties, tournaments, camps, or extra activities.


Electronic Signature Consent

By checking the box below, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


Adelita (Addy) Ffrench

Program Coordinator

Westchester Game Zone / The Westchester Gym

(914) 609-3096

Signature

Sign above — mouse or finger

A signed PDF is downloaded immediately and emailed to you for your records.