Recess Cleveland Liability Release Form

Release and Waiver of Liability and Indemnity Agreement

Last updated 6/6/25
***You do not have to fill out this waiver if:

1) You've completed a waiver with us once this calendar year, you remember the phone number on that waiver, AND you do not need to add any children to the waiver.

Or...

2) You (and your children) only plan on participating in activities that are considered low-risk (board games, art instruction, group games with zero probability of collisions, etc.).

If you have already filled out this form, then please use our self check-in page to look up your profile in our system using your phone number.

If you have not filled out a wavier with Recess Cleveland this year, then please fill out the form below:
Name of Participant*

First NameLast Name
Phone Number*
Event location you're filling out the waiver for*
Email*
example@example.com
Birth Date*

MonthDayYear
Name of Guardian

First NameLast Name
Birth Date of Guardian

MonthDayYear
Would you like to add any additional participants to this waiver?
Additional Participant 1 Name

First NameLast Name
Additional Participant 1 Birthdate

MonthDayYear
Date
Additional Participant 2 Name

First NameLast Name
Additional Participant 2 Birth Date

MonthDayYear
Date
Additional Participant 3 Name

First NameLast Name
Additional Participant 3 Birth Date

MonthDayYear
Date
Additional Participant 4 Name

First NameLast Name
Additional Participant 4 Birth Date

MonthDayYear
Date
Additional Participant 5 Name

First NameLast Name
Additional Participant 5 Birth Date

MonthDayYear
Date
Additional Participant 6 Name

First NameLast Name
Additional Participant 6 Birth Date

MonthDayYear
Date
Additional Participant 7 Name

First NameLast Name
Additional Participant 7 Birth Date

MonthDayYear
Date
Additional Participant 8 Name

First NameLast Name
Additional Participant 8 Birth Date

MonthDayYear
Date
Additional Participant 9 Name

First NameLast Name
Additional Participant 9 Birth Date

MonthDayYear
Date
Additional Participant 10 Name

First NameLast Name
Additional Participant 10 Birth Date

MonthDayYear
Date
I HAVE THE LEGAL AUTHORITY TO EXECUTE THIS CONSENT AND RELEASE FOR ALL PARTICIPANTS LISTED ABOVE*

Yes
I/WE HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I/WE HAVE READ AND UNDERSTOOD IT, AND I/WE AGREE TO BE BOUND BY ITS TERMS. *

Yes
Date

MonthDayYearHourMinutesAM/PM Option
Would you like to receive FREE event invites from Recess Cleveland (FYI - Recess is a 501(c)(3) nonprofit and most of our events are FREE to attend)?*

Yes, please let me know when you're hosting other eventsNo, I'm not interested in attending any other events
Our nonprofit also specializes in distributing toys to kids in need. Do you have any toys or play equipment, in any condition, that you would consider donating to our organization? (Please check all boxes that apply)*

Yes, I have toys and/or play equipment I'm willing to donateI'm interested in becoming a donor / Friends of Recess Cleveland memberI have a friend who may be willing to donate itemsI know a business who may be willing to helpNo, not at this time
Would you like to volunteer at an upcoming Recess Cleveland event?*

Yes, looks like a blast. I would like to join the team.No, but I would like to learn how I can help with recess in other ways.No, not interested at this time, but thanks for asking.
Would you like to learn how you could rent our equipment for free and host events in your neighborhood?*

Yes, I would love toNo, but I would like to learn more about the Play Champion programNo, but I know an organization that may be interestedNo, not interested at all
Signature / Mark

Clear
Should be Empty:

Release and Waiver of Liability and Indemnity Agreement