IMPACTXR YOUTH PARTICIPATION WAIVER & RELEASE FORM
Parent/Guardian Authorization for Minor Participation in Gaming and VR Activities
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This agreement releases ImpactXR, located at 2257 Heath Rd., Macon , GA 31206, from any and all liability relating to injuries that may occur during PlayStation 5 gaming, video game tournaments, and virtual reality (VR) experiences conducted at our facility. By signing this waiver, I confirm that I am the parent or legal guardian of the participating minor and that I understand and agree to the terms below.
1. Acknowledgment of Risk
I understand that PS5 gaming, VR gameplay, and related activities may involve physical movement, exposure to visual and auditory stimuli, and potential risk of discomfort, dizziness, motion sickness, or falls. I voluntarily allow my child to participate in these activities at ImpactXR.
2. Health & Safety Disclaimer
I affirm that my child has no known medical conditions (including epilepsy, severe motion sickness, or other sensitivities) that would be aggravated by gaming or VR participation. I understand that if my child feels unwell during participation, they are to notify staff immediately.
3. Supervision & Conduct
I understand that ImpactXR staff will supervise the environment, but I remain responsible for my child’s behavior. I authorize ImpactXR to dismiss any child from the activity for inappropriate or unsafe behavior
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4. Property Damage/Loss
I understand that my child is expected to treat all equipment with care. I agree to accept financial responsibility for any intentional damage caused by my child to facility property or gaming equipment.
5. Photo/Video Release
I grant permission for ImpactXR to take photographs or video of my child during participation for promotional purposes (e.g., website, flyers, social media).
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6. Liability Waiver
I hereby release and hold harmless ImpactXR, its staff, owners, and affiliates from any and all liability, claims, demands, damages, or causes of action arising from participation in gaming and VR activities.
