PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
In consideration of the services of Poppy’s Pumpkin Patch, their agents, owners, officers, volunteers, participants, employees, and
all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "PPP"), I hereby agree to release,
indemnify, and discharge PPP, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and
estate as follows:
1. I acknowledge that my participation involving the zip line entails known and unanticipated risks that could result in physical or
emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be
eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: the hazards of walking on uneven terrain and slips and falls; rope burns; pinches, scrapes, twists
and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; the
use of ropes, harnesses, and other equipment; the forces of nature, including lightning and rapid weather changes; the risk of falling from
significant heights, standing or walking near slopes and steep cliffs; the risk of exposure to insect bites; the risk of cold including
hypothermia; my own physical condition, and the physical exertion associated with this activity.
Furthermore, PPP employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a
participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings
or instructions, and the equipment being used might malfunction.
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely
voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless PPP from any and all claims, demands, or
causes of action, which are in any way connected with my participation in this activity or my use of PPP’s equipment or facilities,
including any such claims which allege negligent acts or omissions of PPP.
4. Should PPP or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to
indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear
the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I
6. In the event that I file a lawsuit against PPP, I agree to do so solely in the state of Nebraska, and I further agree that the substantive law
of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this
agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I
may be found by a court of law to have waived my right to maintain a lawsuit against PPP on the basis of any claim from which I
have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by
Print Name Phone Number
State Zip Email
Signature of Participant Date
PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)
In consideration of ______________________________________________________________________(print minor's name) ("Minor")
being permitted by PPP to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless
PPP from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or
participation by Minor.
Parent or Guardian: ___________________________ Print Name: ____________
ZIP LINE RELEASE FORM BELOW
Imagine you are dangling high in the air with the wind in your face and soaring across the pumpkin patch! The zip line is poppy’s newest and most thrilling attraction for 2009. The zip line is a 700 ft cable that starts at the look out tour and goes across part of the pumpkin patch and over the pond. It is commercially built. A helmet, harness, and safety line are provided.
This thrilling ride is for kids and adults. So come zip with us! Some restrictions do apply.
400 FT ZIP LINE
IN ADDITION TO OUR
700 FT ZIP LINE!
MUST FILL WAIVER OUT BELOW TO RIDE ZIP LINES. PRINT AND FILL OUT OR GET ONE AT THE ADMISSION BOOTH.