Test Waiver Form

Name the Booking is under: *

Date of Game or Event *

I am 18 years of age or over and I am *

signing for myself
signing for my dependents
signing for myself and my dependents

Name, address, phone number and email of adult participant, parent or guardian ( 18 years of age or older ) :

My First Name *

My Last Name *

My Phone *

My Email *

By providing your email address you authourize ESCAPE MAZE INCORPORATED to send you emails regarding our services; including a copy of this agreement.

First and last names and birthdays of all dependents participating:

Dependent # 1

First Name

Last Name

Date of Birth

Dependent # 2

First Name

Last Name

Date of Birth

Dependent # 3

First Name

Last Name

Date of Birth

Dependent # 4

First Name

Last Name

Date of Birth

Dependent # 5

First Name

Last Name

Date of Birth

Dependent # 6

First Name

Last Name

Date of Birth

My Address *

Address Line 1

City

Province / State / Region

Postal Code / Zip

Country

By signing and submitting this legal document electronically, I confirm that the information I have provided to be true and I understand that providing false information is considered misrepresentation under the law.

Signature of adult participant, parent or guardian ( 18 years of age or older ) *

Phone