Midwest Bounce Party Center Waiver - Parent/Guardian Not Present
PLEASE READ THE FOLLOWING carefully and mark all checkboxes below.
I acknowledge that the use of bouncy houses involves inherent risks, including but not limited to falls, collisions, and injuries. I voluntarily assume this risk for my child(ren).
My child(ren), who will use the Midwest Bounce inflatables and party center, are physically, mentally and emotionally fit to participate in such activities.
I release Midwest Bounce staff, owners, and property owners from any claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury that may occur to myself or my child(ren) on the Midwest Bounce premises.
I agree that my child(ren) will abide by all rules and guidelines set forth by the organizers and understand that failure to do so may result in my removal from the Midwest Bounce party center.
I understand and agree that this release extends to all claims of any kind or nature whatsoever, whether foreseen or unforeseen, known or unknown, and I expressly waive any protections that may be afforded by any statute or law in any jurisdiction. I also understand that this release binds my heirs, executors, administrators, and assigns.
Parent or Legal Guardian - Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Caregiver:
The following individual will be responsible for my child(ren) in my absence. By completing the field below, I authorize the following individual to make decisions for and on behalf of my child(ren) while on the Midwest Bounce premises.
Name
First Name
Last Name
Children:
Full Name - Minor #1:
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Full Name - Minor #2:
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Full Name - Minor #3:
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
*Complete additional forms for additional minors, if needed.
Emergency Contact Information
In case of an emergency, please provide the contact information for someone who can be reached
Name
First Name
Last Name
Relationship to Minor Child(ren):
Phone Number
Please enter a valid phone number.
Photo/Video Release:
During public events, Midwest Bounce & Rentals may take photographs and/or videos of activities involving you and/or the children in your care. These photos may be published on our website, social media pages, and in other marketing efforts. Use of your likeness in photos and videos is optional and will not prohibit you or your child from attending public events at the Midwest Bounce facility. Please designate below whether you consent to the reproduction and publication of photos and/or videos of you and/or the children in your care.
Photo/Video Release Consent:
I hereby allow the reproduction and publication of photos and/or videos of myself and/or my children.
I do not allow the reproduction and/or publication of photos and/or videos of myself or my children.
Date
-
Month
-
Day
Year
Date
Client's Signature
Submit
Submit
Should be Empty: