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Form analysis
1 forms found in the DOM

POST

<form action="" method="POST" id="waiver-form" class="waiver-form">
  <input type="hidden" name="csrfmiddlewaretoken" value="GLaT0zfYIoXFh0TLKKrAldqDDijJaKqoSchCd1n9za9IrLX6QVJapZjTG9y9y1g7">
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_first_name">FIRST NAME</label>
      <input type="text" name="first_name" class="form-control waiver-form-field" required="" id="id_first_name">
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_last_name">LAST NAME</label>
      <input type="text" name="last_name" class="form-control waiver-form-field" required="" id="id_last_name">
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_dob">DATE OF BIRTH</label>
      <input type="text" name="dob" class="form-control waiver-form-field" placeholder="MM/DD/YYYY" required="" id="id_dob">
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_email">EMAIL</label>
      <input type="email" name="email" class="form-control waiver-form-field" required="" id="id_email">
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_phone">PHONE</label>
      <input type="tel" name="phone" class="form-control waiver-form-field" id="id_phone">
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <label class="" for="id_custom_text_1">HOW MANY ROOMS HAVE YOU DONE AT OUR FACILITY?</label>
      <input type="text" name="custom_text_1" class="form-control waiver-form-field" data-field-name="How many rooms have you done at our facility?" required="" id="id_custom_text_1">
      <div class="messages"></div>
    </div>
  </div>
  <!-- EMAIL WAIVER OPTION CHECKBOX -->
  <div class="form-group row no-gutters">
    <div class="col-12 mx-auto max-width-500">
      <div style="display:flex;">
        <input type="checkbox" name="email_waiver_option" class="waiver-form-field" id="id_email_waiver_option">
        <label class="form-check-label" for="id_email_waiver_option" style="padding-left:5px;"> Email a copy of signed waiver to yourself. </label>
      </div>
      <div class="messages"></div>
    </div>
  </div>
  <div class="form-group row no-gutters pt-1">
    <div class="col-2 max-width-500 mx-auto">
      <button id="add-minor-button" class="btn btn-add-minor btn-block" type="button"> ADD MINOR </button>
    </div>
  </div>
  <div id="is-participating-checkbox" class="form-group row no-gutters hidden" style="display:none;">
    <div class="col-12 mx-auto max-width-500">
      <div style="display:flex;">
        <input type="checkbox" checked="" name="is_participating" class="waiver-form-field" id="id_is_participating">
        <label class="form-check-label" for="id_is_participating" style="padding-left:5px;"> Will you as the parent/guardian be participating in the experience? </label>
      </div>
      <div class="messages"></div>
    </div>
  </div>
  <div class="minor-container mx-auto"></div>
</form>

Text Content

7/7/2023 8:00 PM
7/7/2023 @ 8:00 PM
PLEASE READ AND SIGN THE WAIVER

In consideration of being permitted to participate in any/all activities
associated with real life escape the room game, operated by North Valley Escape
Room, LLC of Anthem, Arizona. I hereby waive, release, and discharge North
Valley Escape Room, LLC, its owners, officers, directors, employees, members,
agents, assigns, legal representatives and successors, and all business
associates and partners involved in the presentation of the above noted activity
and each of them their owners, officers and employees, from all liability for or
by reason of any damage, loss or injury to person and property, even injury
resulting in the death of the Participant, which has been or may be sustained in
consequence of the Participant’s participation in the activity described above,
and notwithstanding that such damage, loss or injury may have been caused solely
or partly by the negligence of North Valley Escape Room, LLC.

 I understand that being permitted to participate in the above noted activity,
there are potential risks including but not limited to:

1)       Being enclosed in a reasonably small room with up to 15 people.

2)       Potential tight spaces and low ceilings

3)       Mental stress and similar disorders.

4)       The use of simple tools and objects.

5)       Dim and/or flashing lighting in rooms

6)       Potential loud noises

7)       Potential live actor interaction

 

I acknowledge that while I am participating in the above noted activity, I will
be monitored by video/audio and may be photographed after participating in the
activity described above. I hereby consent to give North Valley Escape Room,
LLC, permission to allow my photograph to be displayed, published or
distributed.

 I acknowledge that I am monetarily liable for intentionally damaging or taking
any items at North Valley Escape Room, LLC.

 I acknowledge that I am not permitted to take photos or video while
participating in the activity described above.

 I acknowledge that I am at least 18 years old. (If the participant is under 18
years old, a Parent/Guardian must sign this waiver.

I acknowledge that I do not currently, and have not in the past 10 days,
suffered from COVID like symptoms.

 I ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS
CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN
MYSELF AND NORTH VALLEY ESCAPE ROOM, LLC, AND SIGN IT OF MY OWN FREE WILL.

FIRST NAME

LAST NAME

DATE OF BIRTH

EMAIL

PHONE

HOW MANY ROOMS HAVE YOU DONE AT OUR FACILITY?

Email a copy of signed waiver to yourself.

ADD MINOR
Will you as the parent/guardian be participating in the experience?


SIGN WAIVER

PLEASE SIGN YOUR NAME

×

Clear SUBMIT