DISCLOSURE AND RELEASE FROM LIABILITY

 

1. Disclosure of Risk. The PAINSTATION is a two-person console, similar to a PacMan console,that has two metal plates with sensors where each player places their left hand. Players must keep their hand on the metal plates or the game stops. The game is a video game, similar to “Pong.” The two players play the game and the loser gets his/her left hand shocked, zapped or whipped. The pain is caused by heat, electric shock, or a small whip. If a person plays the game continuously for an extended period of time he/she can end up with wounds on his/her hand. Participation in the PAINSTATION can cause burns on the palm of the hand, skin abrasions, swelling, and/or bruises on the back of the hand. It can also lead to circulatory disturbances.

 

2. Assumption of Risk. I am participating voluntarily in the PAINSTATION with knowledge of the risks involved. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS INCLUDING, BUT NOT LIMITED TO, BURNS ON THE PALM OF THE HAND, SKIN ABRASIONS, SWELLING, AND/OR BRUISES ON THE BACK OF THE HAND OR CIRCULATORY DISTURBANCES.

 

3. Certification. I certify that I am 18 years old or older. I also certify that I do not have any of the following medical conditions: AIDS, HIV, HEPATITIS, HEMOPHILIA, EPILEPSY, HEART DISEASE (ESPECIALLY THOSE REQUIRING CARDIAC PACEMAKERS), HIGH BLOOD PRESSURE, ANY MEDICAL CONDITION(S) THAT COULD BE AGGRAVATED, TRIGGERED OR TRANSMITTED BY PARTICIPATING IN THE PAINSTATION, OR ANY OTHER DISEASE(S) OR CONDITION(S) COMMUNICABLE BY BLOOD OR SKIN CONTACT. I also certify that I am not hypersensitive to pain, that I do not suffer from fainting spells or dizziness, and that I am willing to suffer from burns or shocks. I VERIFY MY STATEMENTS IN THIS PARAGRAPH BY PLACING MY INITIALS HERE: ___________.

 

4. Release. I acknowledge that the Yerba Buena Center for the Arts is not the agent of the Redevelopment Agency of the City and County of San Francisco (hereinafter referred to as the “Agency”) or of the City and County of San Francisco (hereinafter referred to as the “City”) or their respective employees, contractors, agents, members, or officers. As consideration for being permitted by the Yerba Buena Center for the Arts to participate in the PAINSTATION, I hereby release the Yerba Buena Center for the Arts, the artist group Fur and its individual members, the Agency, the City, and their respective directors, officers, trustees, insurers, attorneys, consultants, affiliates, employees, contractors, agents, and members from all actions, claims, or demands that I, my assigns, heirs, and legal representatives now have or may have in the future for any loss, liability, injury, or damage resulting from my participation in the PAINSTATION.

 

5. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT THAT IS BINDING. I HAVE SIGNED THIS CONTRACT OF MY OWN FREE WILL.

Executed on __________________, 2004 at San Francisco, California.

 

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6. Declaration of Witness. I certify that ________________________________________ acknowledged in my presence that he/she read and fully understood the meaning and consequences of the foregoing release, and signed it in my presence.

Executed on __________________, 2004 at San Francisco, California.

 

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