In consideration of being allowed to participate in any way in the program, related events and
activities, and use of equipment, I the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the
potential for paralysis and death.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full
responsibility for my participation.
3. I willingly agree to comply with terms and conditions for participation. If I observe any
unusual significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention of the nearest official immediately.
4. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of
kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Host, it’s officers, officials,
agents, and/or employees, other participants, sponsors, advertisers, and if applicable,
owners and lessors of premises used to conduct the event (RELEASEES), from any and all
claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY
OR DEATH I may suffer, or loss or damage to a person or property, WHETHER ARISING
FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
I will notify Jacob’s Chance ownership or employees if I suffer from any medical or
health condition that may cause injury to myself, others, or may require emergency care
during my participation.
1365 Overbrook Rd,
Richmond, VA 23220
By agreeing below, I hereby grant and convey to Jacob’s Chance all right, title and interest
in and to record my name, image, voice, or statements including any and all
photographic images and video or audio recordings made by Jacob’s Chance
The Venue of any dispute that may arise out of this agreement or otherwise between
the parties to which Jacob’s Chance or its agents is a party shall be either the Richmond
City, VA Justice Court, or the County or State Supreme Court in Richmond City, VA.