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Electronic Signature and Acknowledgement
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JCK LLC (Back Alley Axe)

In consideration of being allowed to participate in the program, activities and events of JCK LLC at its premises, I acknowledge, appreciate, and agree that:

 

1.       I am aware of the physical nature and inherent risks of serious bodily injury, death, property damage and/or loss associated with the activity which all participants must assume; and ,

 

2.       I knowingly and freely assume all such risks, even unknown, even if arising from the negligence of the Releases (as hereafter defined) or others, and assume full responsibility for my participation and use of such facility, equipment and property’ and,

 

3.       I do not have any physical, mental or emotional conditions or impairments which would affect, limit or preclude my ability to participate in this activity; and,

 

4.       I am not under the influence of any substances, including alcohol, illicit drugs or prescription medication, which may affect and/or impair my coordination, judgment, to perform this activity; and,

 

5.       I have inspected the equipment and I will use for this activity and find it to be fit for my use in his activity; and,

 

6.       I have been made aware and understand all rules for my participation in this activity and further understand that it is my sole responsibility to follow those rules set forth and maintain my own personal safety; and,

 

7.       I will immediately remove myself from participation, and notify the nearest representative of Back Alley Axe.  If at any time I sense any unusual hazard or unsafe condition or I feel I have experience any deterioration in my physical, emotional or mental fitness to continue participation in the activity.

 

8.       I hereby authorize and give my consent to the staff, representatives and or employees of Back Alley Axe to terminate my participation in the activity without refund if at any time by the sole discretion of the staff of Back Alley Axe for safety reasons that could endanger yourself, staff or other participants.

 

9.       I hereby authorize and give my consent to the staff of Back Alley Axe to act on my behalf to secure medical treatment for the administration of all emergency medical problem should arise while on the premises. 

 

10.   I agree to assume all costs related to such treatment and or transportation and understand I am solely responsible for any medical or charges in connection with my participation in the activity at Back Alley Premises.

 

11.   I hereby authorize and give my consent to the disclosures of the medical information to the extent such is necessary for the provision of emergency medical and or emergency medical surgical treatment.

 

12.   I hereby authorize and give my consent to Back Alley Axe, its members, managers and employees, collectively, non-revocable permission to capture my image and likeness in photographs, videotapes, or any other forms of media.  I acknowledge that Back Alley Axe will own such images and grant Back Alley Axe permission to copyright, display, publish, distribute, use modify, print and reprint such images in any manner whatsoever related to the Back Alley Axe business including without limitation, publications, advertisements, brochures, web sites and or social media posts or other electronic displays or transmissions thereof.  I further wave any right to inspect or approve the use of the image by Back Alley Axe prior to its use.  I forever Release and hold harmless Back Alley Axe from any and all liability arising out of the use of the images in any manner of media whatsoever, and waive any and all claims and causes of action relating to the use of the images, including without limitation, claims for invasions of privacy rights or publicity .

 

13.   I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, herby release, waive, discharge and covenant not to sue JCK LLC (Back Alley Axe), employees, managers, representatives, subsidiary entitles, agents, successors and assigns(releases) with respect to any and all injury, disability, death, or lose or damage to person or property, whether arising from the negligence of the release of otherwise, to the fullest extent permitted by law.

 

14.   I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin.  Hereby further agree to indemnify and save and hold harmless the releases and each of them, from any loss, liability, damage or cost they man incur arising with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the release or otherwise to the fullest extent permitted by law.

 

15.   Governing law and jurisdiction.  The laws of the commonwealth of Pennsylvania shall govern the validity, construction and enforceability of his agreement, without giving effect to its conflict of laws principles.  All suits actions, claims and causes of action relating to construction, validity, performance and enforcement of this agreement shall be in courts of the commonwealth of Pennsylvania.

 

I have read this release of liability and assumption of risk agreement, fully understand its terms and understand that I have given up substantial rights by singing it, and sign it freely and voluntarily without any inducement.