Rage Room Waiver Form
Please read and sign the waiver before participating in the Rage Room experience.
Participant's Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I acknowledge that I am participating in the Rage Room experience at my own risk. I understand that this activity involves physical exertion and the potential for injury.
I Agree
I Do Not Agree
I hereby release and hold harmless the Rage Room, its owners, employees, and agents from any and all claims, liabilities, or damages arising from my participation in this activity.
I Agree
I Do Not Agree
I confirm that I am at least 18 years of age, or if under 18, I have obtained parental consent to participate in this activity.
I Agree
I Do Not Agree
Do you have any medical conditions or injuries that we should be aware of?
Signature of Participant
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: