Group Name (if applicable)
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Name of Adult - Must be at least 18 years of age
Contact Information
Address
DOB
Drivers License
DL State
How many children do you need to add to this waiver?
None
1 child
2 children
3 children
4 children
5 children
6 children
7 children
8 children
Waiver
"In consideration of being allowed to enter the play area and/or participate in any party and/or program at PlayWerx Inc., the undersigned, on his or her behalf, and on the behalf of the participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:
I represent that I am the parent or legal guardian of the participant(s) named below, or have obtained permission from the parent/legal guardian of the participant(s), named below to execute this agreement on their behalf. I agree that the participant(s) named below and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participating in any party and/or program at PlayWerx, Inc. In addition, if I observe any hazard during our participation I will bring it to the attention of the nearest PlayWerx, Inc. employee or official immediately. I am aware that there are inherent risks associated with participation in PlayWerx, Inc. programs, parties, and/or use of the play-structure and other play areas and I on behalf of myself and the participant(s) named below, knowingly and freely assume all such risk, both known and unknown including those that may arise out of the ordinary negligence of other participant(s), and, I for myself and the participant(s) named below and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless PlayWerx, Inc., their affiliates, officers, members, agents, employees, other participants and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our participation in any and all PlayWerx, Inc. programs, activities, parties, the use of the play-structure, and/or other play areas.
Video, Photo, Image Release:
This agreement gives PlayWerx, Inc., rights and permissions to use all media captured on PlayWerx premises including, but not limited to, photos and videos. This media can be used for any and all purposes including, but not limited to, publication in both printed and electronic media, internet, websites, advertising, and other promotional uses. "
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT AND SUBMITTING THIS FORM, AND I AM SIGNING IT AND SUBMITTING THIS FORM FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
IP: 3.145.186.173
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