Waiver | The Play Caf Englew

Waiver of Injury & Illness

Caregiver First Name

Caregiver Last Name

Phone

Is your child symptom free of spreadable, transmissable illnesses such a strep throat, pink eye, flu, ring worm, diarrhea etc, and does not currently have a fever? (staff reserves right to ask you to leave if your child presents with symptoms during their time here)

Yes

All Childrens Full Name & Date of Birth (INCLUDE ALL CHILDREN)

I declare that the info I’ve provided is accurate & complete

In consideration of being allowed to enter the play area, use playground equipment, or to participate in any party and/or program at The Play Cafe LLC- Englewood, the undersigned, on his or her behalf, and on behalf of the minor(s) identified below acknowledges, appreciates, agrees and is fully aware of the risks and hazards in participating in any of the activities on the premises of The Play Cafe LLC- Englewood, and further agrees as follows: I agree for myself and/or the minor(s) listed below that we shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for play and participation in any party and/or program at The Play Cafe LLC- Englewood and agree to pay for all damages to the facilities of The Play Cafe LLC- Englewood caused by myself or the listed minors’ negligent, reckless, or willful actions. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest The Play Cafe LLC- Englewood employee or official immediately. I recognize and understand that there are certain inherent risks associated with use of the play area, parties, and programs and that risks of injury include, without limitation, scrapes, bruises, cuts, and even more serious injuries, such as paralysis or death. Moreover, for myself and the minor(s) named below, I fully accept and agree to assume all of these risks (including risks arising from the negligence of other participants), and I assume full responsibility for personal injury to myself and the listed minor(s) and our respective heirs, assigns, administrators, personal representatives, and next of kin, waive, release and discharge The Play Cafe LLC- Englewood and Duloc Englewood, its affiliates, officers, members, agents, employees, other participants, and sponsoring agencies for injury, loss or damage arising out of or related to our participation in any and all of The Play Cafe LLC- Englewood programs, activities, parties, and/or the use of the facilities of The Play Cafe LLC- Englewood. This waiver and release shall be binding and apply to all risks, known and unknown, even if resulting from negligent actions of other guests or employees of The Play Cafe LLC- Englewood. Each participant must have a waiver form signed, either by them or if you are under the age of 18 years, then signed by a parent/legal guardian or designated representative by parent/legal guardian. If a waiver is not signed, the person will not be able to participate in The Play Cafe LLC- Englewood programs, parties and or use of the play area. “Rules of Play” include and are not limited to (a) Socks must be worn (no shoes or bare feet) on the Playground if being used on site for the event. (b) No walking or running down slides (must be in a seated position – legs first). (c) Adults must always supervise their children. (d) must use good judgment when using play equipment. (e) understanding play equipment is not recommended for children over 10 years of age or over 80 pounds. I represent that I am the parent or legal guardian of the minor(s) named below, or I have obtained permission from the parent/legal guardian of the minor(s) named below to execute this agreement on their behalf. I further represent that the participants are healthy and physically able to participate in any and all undertaken activities. I consent to the reproduction, use, and distribution of pictures, videos and sound for the purpose of promotion and advertising to be used in electronic, print and Internet media. By checking the box to the left you agree to above statements. By submitting form, it will act as your signature tha ou agree to submit agreement to terms of Liability Waiver.

Your Signature

Your Form Has Been Submitted