Keep Calm Sensory Zone liability waiver.
Please share with us the name of all family members living in your household.
Parent/Adult/Guardian name #1
*
First Name
Last Name
Parent/Adult/Guardian name #2
First Name
Last Name
Additional Adult who may bring the child(ren)
First Name
Last Name
Additional Adult who may bring the child(ren)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of child #1
*
Date of Birth for child #1
Name of child #2
Date of Birth for child #2
Name of child #3
Date of Birth for child #3
Name of child #4
Date of Birth for child #4
Name of child #5
Date of Birth for child #5
By signing this agreement, I acknowledge and accept the following terms on behalf of myself and my child (the “Participant”) regarding participation in activities at Keep Calm Sensory Zone (“KCSZ”): I voluntarily agree to release, waive, and hold harmless KCSZ—including its owners, employees, volunteers, partners, and affiliates—from any and all liability for injuries, damages, or losses that may occur as a result of my child’s participation in KCSZ activities. This release applies to all individuals and entities associated with KCSZ now and in the future. I also agree that no member of my family, including my spouse, children, or any other representative, will pursue legal action against KCSZ or any related party in connection with such participation. To the best of my knowledge, my child does not have any health conditions that would make participation unsafe. I understand and agree that this waiver will remain in effect for all future visits to this KCSZ location and that I do not need to sign a new agreement each time. I recognize that participation in activities at KCSZ carries both known and unforeseen risks, which may include—but are not limited to—scrapes, bruises, cuts, rug burns, sprains, broken bones, or more serious injury. These risks are inherent in active play and cannot be fully eliminated without changing the nature of the experience. I understand that if my child is injured and requires medical attention, I will be fully responsible for all medical costs. I acknowledge that while KCSZ staff strive to maintain a safe environment, they may not always be aware of my child’s abilities, and unforeseen issues such as unclear instructions, supervision challenges, or equipment malfunctions may occur. I knowingly and willingly accept these risks and choose to allow my child to participate. I certify that I have adequate insurance coverage for any injury or damage my child may cause or experience while participating in KCSZ activities. If I do not have such insurance, I agree to assume full financial responsibility for any resulting costs. I further agree to accept any risks associated with my child’s known or unknown medical or physical conditions.In the event of an emergency, I authorize Keep Calm Sensory Zone (KCSZ) staff, employees, or volunteers to seek and secure medical care for my child (the Participant) if I cannot be reached in a timely manner. This includes permission to administer basic first aid and to contact emergency services (such as EMS or 911) if necessary. I understand that KCSZ staff are not medical professionals and are not responsible for the outcomes of medical care administered by emergency responders or medical providers. I agree to be fully responsible for any and all costs associated with medical treatment or emergency care for the Participant. I further release and hold harmless KCSZ and all affiliated parties from any liability related to the medical care decisions made on behalf of my child in good faith during an emergency. For the safety and well-being of all participants, I understand that my child is expected to follow the rules of Keep Calm Sensory Zone (KCSZ) and treat staff, peers, and equipment with respect. I acknowledge that disruptive, unsafe, or aggressive behavior may result in my child being temporarily or permanently removed from the activity or facility at the discretion of KCSZ staff. I understand that if my child is removed due to behavioral concerns, I will be contacted and required to pick them up promptly. I also understand that refunds will not be provided in such cases. Repeated or serious behavioral issues may result in suspension or termination of participation in future programs or visits. This agreement is governed by the laws of the State of Wisconsin. If any portion of this agreement is found to be invalid or unenforceable, the remaining sections shall continue to be fully valid and enforceable. I agree that any legal action brought related to this agreement or KCSZ must be filed in the state of Wisconsin, and Wisconsin law will apply. Additionally, I agree to indemnify and hold harmless KCSZ from any claims or lawsuits arising from my child’s participation, including those alleging negligence by KCSZ or its staff, except in cases where KCSZ is solely responsible due to willful misconduct or gross negligence. By signing below, I affirm that I have read this agreement in full, understand its contents, and willingly agree to be bound by its terms.
Signature
Photo Release
I give Keep Calm Sensory Zone (KCSZ) and its partners permission to take photos and/or videos of me or my child (the participant) during any KCSZ activities. I understand these images and recordings may be used—now or in the future—for things like advertising, social media, or promotional materials in any format, worldwide, and without time limit. I agree that KCSZ can edit or use these images however they choose, and I will not receive any payment or have the right to review or approve how they are used. All images and recordings will belong solely to KCSZ.
Signature
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