Game Room Access Form
Game Room Access Form
This form is valid from August 1, 2020 to May 7, 2021
Name
Name
*
First
Last
Badge # (5 digit number on the bottom right on the back of your ID)
*
Must be
5
characters.
Currently Entered:
0
characters.
Phone
Phone
*
-
###
-
###
####
Campus Email
*
GENERAL INFORMATION
The Game Room, located in the Student Center offers a friendly, relaxing atmosphere where students can unwind and socialize with friends and others who share similar interests. Special features include Pool Tables, Shuffleboard, Air Hockey, Ping-Pong, Pac Man Table, Bubble Hockey, Foosball, Board Games, Video Games, and Big Screen Televisions.
The Game Room hours are Sunday thru Friday 8:00 a.m. to 11:00 p.m., with Friday and Saturday closing at Midnight.
POLICIES
General Use
• Large game furniture may not be moved from its original location (Pool, Shuffleboard, Ping-Pong, Air Hockey, Bubble Hockey, Pac Man Table and Foosball tables).
• Proper use of game equipment is expected. No leaning, sitting, or inappropriately using any piece of equipment.
• Food and beverage may not be placed on game equipment. Dispose of all trash, and leave area neat for the next person.
• Game equipment cannot leave the Game Room.
• The College is not responsible for lost or stolen items.
• College policies regarding conduct, alcohol, tobacco, illegal substances and firearms will be enforced.
• Pets are not permitted, except those providing assistance to individuals with disabilities.
• Individuals are required to pick up after themselves, discard trash and remove personal items.
• Report all injuries and any equipment failures to the Student Activities Coordinator.
USER AGREEMENT
By checking the box below I acknowledge that the use of the Game Room may subject me to the risk of bodily injury, property damage or other danger. I freely assume such risk of bodily injury and/or death that may be sustained by me as a result of my use of the Game Room, whether caused by the negligence of Peru State College, its agents and employees or otherwise. On behalf of myself, my personal representatives, heirs, assigns and next of kin, I hereby release, waive, and forever discharge the Board of Trustees of the Nebraska State Colleges, the Nebraska State College System, Peru State College, and all Trustees, administrators, agents, employees, and students (together, the “Released Parties”) from any and all liability, including claims or lawsuits related to any property damage, property loss, bodily injury (including but not limited, to loss of life), or any other loss related to the use of the Game Room. I understand that I am responsible to pay, or otherwise cover through insurance, any medical or hospital expenses, doctor bills or other expenses which could be incurred as a result of my use of the Game Room.
I agree to exercise special care to avoid damage to the Game Room and the property of others. I agree that the Released parties shall not be responsible or liable for the loss or theft of property from the Game Room, any lockers or storage areas.
I agree to abide by all of the policies issued with respect to the Game Room and any instructions given to me regarding the use of the Game Room. I agree that permission to use the Game Room may be withdrawn at any time and for any or no reason.
I understand that by signing this document that I assume responsibility for its condition, and will accept any and all charges that go towards replacement or repair in the event that the equipment is damaged due to my negligence, recklessness or willful actions.
I understand that Peru State College will place a hold on my Student Account if damaged item(s) have not been paid for by the end of the semester the equipment was damaged.
My signature below confirms my consent to, and my compliance with this Agreement. A copy of this document will have the same effect as the original.
User Agreement
*
User Agreement
I have read, understand, and agree to the user agreement above.
Date
Date
*
/
MM
/
DD
YYYY
Draw your signature into the box below.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.