PLAYOPOLIS LLC d/b/a SCRAMBLE
PARTICIPANT AGREEMENT, ASSUMPTION OF RISK,RELEASE OF CLAIMS, AND WAIVER OF LIABILITY
(PLEASE READ THIS FORM COMPLETELY AND CAREFULLY)
I, the undersigned, wish for my minor child to participate in the activities, events, and programs offered by and through Playopolis LLC d/b/a Scramble and its owners, members, officers, employees, volunteers, agents and all other individuals and entities acting in any capacity on its behalf (collectively referred to as “Scramble”). I understand that all individuals wishing to participate in a Scramble activity, event or program are required to review and submit a completed Participant Agreement, Assumption of Risk, Release of Claims, and Waiver of Liability (the “Agreement”). I acknowledge that I have read the rules (the "Rules") governing my child’s participation, and the participation of those under my supervision, in Scramble activities, events, and programs, and that I have explained the Rules to those under my supervision. I acknowledge that failure to follow the rules could result in the expulsion of myself and those under my supervision. I certify that my child is physically able to participate in Scramble activities, events, and programs without aid or assistance.
I understand and acknowledge that Scramble activities, events, and programs for my child will involve use of Scramble’s premises and facilities, including, but not limited to its: play space; recreational equipment and structures; sports courts; food service area; changing, waiting and related areas, and may involve, strenuous physical exertion, physical impacts, and activities off the ground that are inherently high risk.
I acknowledge that I am entering into this waiver and release of liability knowingly and voluntarily on behalf of my child. I hereby assume, on behalf of my child, myself, and my spouse, heirs, assigns personal representatives, estate, insurers, and any individual for whom I have legal responsibility, all risks associated with my child’s participation in Scramble activities, events, and programs. I fully acknowledge and recognize that risks may be involved in Scramble activities, events, and programs, and that such risks may include physical or psychological injury, including but not limited to illness, disease, paralysis, death, damages, economic or emotional loss, that my child may suffer as a direct or indirect result of my child’s participation in the Scramble activities, events, and programs, including travel to and from such activities, events, and programs.
I expressly agree, in consideration of my child being permitted to participate in Scramble activities, events, and programs, that I fully accept and assume all such risks and all responsibility for losses, costs, or damages incurred by my child that may be caused by my child’s own actions or inaction or the actions or inaction of others participating in Scramble activities, events, and programs. I represent that my child is physically able to undertake any and all such activities, events and programs. If, at any time, I believe conditions to be unsafe, I will immediately discontinue my child’s participation in the Scramble activity, event, or program.
I on behalf of my child further agree to release Scramble and its owners, members, officers, employees, volunteers, agents and all other individuals and entities acting in any capacity on its behalf Scramble (collectively “Scramble”), and hold harmless and indemnify Scramble from all damages, claims and liability, including expenses, costs and attorneys’ fees, as a result of my child’s voluntary participation in Scramble activities, events, and programs, to the extent that those claims and liability are caused by my or my child’s own negligence or willful misconduct, or are caused by the negligence or willful misconduct of others participating in the activities, events, and programs, to the fullest extent allowable by law. I further agree that Scramble assumes no responsibility for the welfare of my child’s property or belongings in this sport or activity. I understand that Scramble does not provide health insurance for individuals participating in Scramble activities, events and programs. As such, my child’s personal health insurance will be responsible for payment of medical services and care for any injuries sustained by my child during a Scramble activity, event or program. In the event that my child requires medical attention relating to my child’s participation in a Scramble activity, event, or program, I understand that all reasonable attempts will be made to contact my designated emergency contact, at the emergency number(s) I have provided. If contact with my designated emergency contact is not reasonably possible, I authorize qualified emergency care personnel to hospitalize, secure treatment for, and take whatever medical action(s) are necessary to treat my child. I further authorize Scramble to contact my designated emergency contact about my child’s physical or mental health during the activity, event, or program, if Scramble deems it advisable to do so.I on behalf of my child authorize Scramble to record and publish all photographs and videos in which my child appears or speaks that are taken by or for Scramble (“Recordings”). I agree that Scramble may use, reproduce, publish, perform or distribute these Recordings, for any purpose, including promotional and advertising use, alone or in combination with other recordings, in all media (print and electronic). Recordings may be edited, e.g. to conform to space and time requirements, applicable laws and regulations, telecast and publishing policies, and to insert commercials and other announcements. This right and permission includes, but is not limited to, use of my child’s name, voice, photograph or likeness, and biographical information, to the extent permitted by law. I on behalf of my child release all claims against Scramble and others with respect to the copyright, publication, or use of such photographs or videos, including any claim for compensation related to the use of the Recordings permitted herein.
Any dispute or controversy between the parties hereto arising out of or relating to this Agreement, the use of Scrambles facilities, or participation in Scrambles activities, events, and programs, shall be governed by the laws of the Commonwealth of Virginia, without regard to its conflict of law rules, and shall be resolved in a court of competent jurisdiction in the City of Alexandria, Virginia. I HEREBY FURTHER AGREE TO WAIVE MY RIGHT TO TRIAL BY JURY. I agree and understand that this agreement is intended to be as broad and as inclusive as permitted by Virginia law and if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect. I understand and affirm that there are no other representations, warranties, promises, or understandings, written or oral, regarding the subject matter of this Agreement, and that I will bound by the terms of this Agreement. I have had reasonable and sufficient opportunity to read and understand this entire document and consult with legal counsel, or have voluntarily waived my right to do so. I knowingly and voluntarily agree to be bound by all of the terms and conditions set forth herein. I represent that I have the actual authority to and do hereby enter into this agreement on behalf of, and as an authorized agent of, the parents of any minor on whose behalf I am signing this Agreement, or as the parent or legal guardian of any child(ren)/ward(s) listed on this Agreement. I have read and knowingly and voluntarily have signed this agreement and specifically the release contained herein and further agree that no oral representations, statements or inducements have been made to me.
I acknowledge that I have read this document carefully and fully understand its contents. I agree that, should any provision or aspect of this Agreement be found to be unenforceable, that all remaining provisions of the Agreement will remain in full force and effect.