***REQUIRED or NO SMASHING***

Welcome to WreckIt Rage Room!

To keep things safe and fun, a parent or guardian must review and complete this short waiver.

✅ Thanks for your payment! Before we can start the session, this short form must be completed to confirm you understand the safety rules and emergency procedures.

1. Guardian / Main Contact Information

💡 If you’re the parent/guardian signing, this is your info. If you’re 18+ signing for yourself, enter your own details.

Guardian First Name *

Guardian Last Name *

Guardian Email *

Guardian Phone *

2. Participant Information

First Name of Participant *

Last Name of Participant *

Participant Date of Birth *

Appointment Date *

3. 📞 Emergency Contact

Who should we call if there’s an emergency during the session?

Is the emergency contact the same as the guardian? *

✅ Yes — Use my (the guardian’s) details above as the emergency contact.

🚫 No — I’ll provide a different emergency contact below.

Emergency Contact Name *

Emergency Contact Phone *

✅ Emergency Medical Consent (Checkboxes): *

I authorize WreckIt Rage Room staff to arrange for emergency medical care if needed and accept responsibility for any related costs.

I understand that WreckIt Rage Room staff may act in my best interest in the event I cannot be reached during an emergency.

✅ Please check both boxes to give emergency medical consent. This is required for all participants — even if the emergency contact is the same as the guardian.

4. ✅ Agreement

I agree to the Terms of Service and Privacy Policy, and I understand how my booking, cancellations, and personal information are handled.

(This must be agreed to before proceeding)

5. 📋 Important Age & Guardian Requirements

Please review the rules carefully to ensure safe participation.

📅 Minimum Age: Participants must be at least 8 years old.
👶 Ages 8–13: A responsible adult (18+) must be inside the rage room at all times with the minor. One adult is required for every 3 minors under age 13.
👦 Ages 14–17: A parent or guardian must remain on-site in the building during the session.
📝 All minors (8–17): A parent or legal guardian must complete and sign this waiver prior to arrival.

6. ⚠️ Assumption of Risk, safety, and Liability Waiver

7. ✍️ Signature

By signing below, I confirm that I am legally authorized to complete this waiver and accept all terms on behalf of myself or the participant listed above.

Signature of Participant (if 18+) OR Parent/Guardian (if under 18) *

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