Bungee Jump Waiver

DRAFT FOR OWNER, MISSISSIPPI COUNSEL AND INSURER REVIEW. This product is imported disabled. Do not use it to admit participants or authorize rentals until its terms, legal operator identity, age/capacity rules and activity-specific requirements are approved.

Free form for one participant and one visit. Version: CEC-2026-10-18-DRAFT-1.

Parties and scope

The operator is the legal owner/operator doing business as Carthage Event Center at the address below (the Center). The participant or renter and signer are identified in the required fields. For purposes of the release below, Released Parties means that operator and its owners, employees and volunteers acting within their roles. The exact legal operator name must be confirmed before this draft is used. This form covers only the activity or booking named here and the visit or event date entered. It does not cover other attractions or future visits automatically.

Activity-specific risks

Bungee jumping can involve falls from height, rapid acceleration and deceleration, rebound, swinging, inversion, impact with structures or people, harness pressure, cord or attachment failure and suspension-related injury. These hazards can cause head, neck, back, eye, joint or internal injury, permanent disability or death.

Activity rules

This form applies only to the exact bungee device and operator identified below. It must not be reused for a bungee trampoline or a different jump system without revising the terms. Participate only after the authorized operator checks eligibility and completes the manufacturer’s harness, connection and equipment procedures. Do not adjust or unclip equipment, enter a jump zone without direction, or attempt unapproved maneuvers. The operator’s weather limits and instructions control. This form does not authorize operation of an unapproved or uninsured attraction.

Health and safety

I will assess my ability to participate and seek advice from my own health professional when appropriate. I will not participate while impaired or when illness, injury, pregnancy, medication effects or another condition makes the activity unsafe or conflicts with the equipment manufacturer’s restrictions. I will follow posted rules, operator instructions, protective-equipment requirements and applicable age, height and weight limits. I will stop immediately if I feel unwell, observe a hazard or am instructed to stop. Staff may refuse or stop unsafe participation. I will discuss accommodation needs privately with staff; this form does not require medical diagnoses.

Personal property, theft and damage

I remain responsible for securing my belongings, vehicles, equipment and valuables. The Center is not accepting custody of them and does not provide storage insurance or guarantee protection from theft, loss or damage. Any release of a property-loss claim is subject to the limitations above; this clause does not excuse liability that cannot legally be waived. I will promptly report hazards, damage, missing items and incidents to staff.

Assumption of risk and limited release

I understand the specific risks described in this agreement and voluntarily choose to participate or carry out the identified booking. These risks can cause damage to property, theft or loss, illness, serious injury, permanent disability or death. To the fullest extent Mississippi law permits, I release the Released Parties from my own claims arising from these described risks, including claims alleging their ordinary negligence in the preparation, supervision, instruction, operation or maintenance of the identified activity, premises or equipment. This is a request to give up legal rights, not a promise that the release is enforceable. This agreement does not release gross negligence, reckless or intentional misconduct, or any duty, claim or liability that cannot lawfully be released. It does not waive an independent claim belonging to another person.

Parent or legal guardian

A parent or legal guardian must complete the form for a participant who cannot legally consent. I represent that I have the authority indicated in the signer-role field. I consent to the identified child’s participation only as allowed by the operator and accept responsibility for providing required supervision and communicating the rules. A parent’s signature does not guarantee an enforceable release of the child’s claims. This form does not purport to waive claims the signer has no legal authority to waive, and it does not require a parent to reimburse the Center merely because a child brings a claim. Staff must confirm signer capacity and any additional consent required for participants under 21 before use.

Emergency response

If an emergency occurs and I cannot provide instructions, I authorize staff to contact emergency services and the listed emergency contact, and to provide assistance within their training. This does not authorize staff to practice medicine or replace consent required by law. Responsibility for medical charges remains as provided by law and any applicable insurance.

Electronic consent and record

I have read the complete agreement, understand it includes a release of legal claims, and have had an opportunity to ask questions before signing. By selecting the required agreement statements, typing my own full legal name as my electronic signature and completing checkout, I intend to sign version CEC-2026-10-18-DRAFT-1. I consent to an electronic record. I may ask for a paper alternative before signing and may save or print the terms. Adding this product to the cart alone does not submit the form. Use the same email as your store account and complete checkout; the submitted fields are recorded with the order. The checkout timestamp records submission time. A typed signature does not independently verify identity.

Applicable law and limits

Mississippi law applies, subject to any controlling law. If a provision is held unenforceable, the remaining provisions apply only to the extent permitted by law. No provision removes the Center’s nonwaivable health and safety obligations. No general admission, attraction ticket, reserved time, rental payment or insurance is included with this free form.

Carthage Event Center, 511 East Franklin Street, Carthage, Mississippi. Questions or assisted completion: 601-741-8328.

Illustrative artwork; it does not show the actual facility or promise that an attraction is open.