I represent that I am a parent or legal guardian of the participant(s) named above, or I have obtained permission from a parent/legal guardian of the participant(s) named above to execute this agreement on his or her behalf. I agree that the participant(s) named above and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party, program, and/or Drop-off playgroup services offered at Kids Wood Play Cafe. In addition, if I observe any hazard while on Kids Wood Play Cafe property, I will bring it to the attention of the nearest Kids Wood Play Cafe employee or official immediately. The information on this form is complete and accurate, and I have provided Kids Wood Play Cafe with all of the necessary information to properly care for the participant(s).
Any items brought from home must be labeled with the participant’s name. Toys from home are not permitted. Kids Wood Play Cafe is not responsible for any lost, damaged, or stolen items.
It is my responsibility to arrange for the participant(s) to be picked up from Kids Wood Play Cafe within the one (1) hour time limit. If the participant(s) is(are) not picked up on time and attempts to contact me have failed, another Authorized Person will be contacted. In order to pick up a participant from Kids Wood Play Cafe, All Guardians and Authorized Persons must provide photo identification. In the event no Authorized Person can be reached, Kids Wood Play Café staff will contact Child Protective Services and/or police officials for further instructions.
In the event of an emergency, Kids Wood Play Cafe will attempt to contact me. If I cannot be reached, Kids Wood Play Cafe is authorized to contact one of the above Emergency Contacts. In the event no Emergency Contact can be reached, Kids Wood Play Cafe is authorized to act for me according to their best judgment in obtaining emergency medical treatment for any participant(s) named on the reverse. Because some children may be allergic, participants may not bring any peanuts, peanut butter, or other nuts onto the premises.
In the event my child needs to use the bathroom, I give Kids Wood Play Cafe staff permission to accompany them if necessary to ensure my child’s safety. If I am not comfortable with this, I will let staff know in writing upon drop-off. I hereby testify that my child is toilet trained and that they can use the bathroom with the accompaniment of a staff member (depending on age and need) as necessary.
I am aware that there are inherent risks associated with participation in Kids Wood Play programs, parties, and/or Drop-off playgroup, and I, on behalf of myself and the participant(s) named on the reverse, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants; and,
I, for myself and the participant(s) named above, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, Kids Wood Play Cafe, and Play Café Corporation management, 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 Play Café Corporation programs, activities, parties, and the use of the play area.