As parent or legal guardian of the child(ren) whose name(s) is/are set forth above (who is/are referred to herein as the “Participant(s)”) and in consideration of the Participant(s) being permitted to participate in the activities at The Play Room @ Rogue Pediatric Therapies, LLC, the Participant(s) and I agree as follows:
This Waiver covers risks of death, serious injury, and property loss whether arising from (a) negligence or carelessness on the part of the persons or entities being released and other participants, or (b) dangerous or defective equipment. Notwithstanding these risks and other hazards that may be foreseeable and unforeseeable but not specifically identified herein, I, for myself and the Participant(s) and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any injury arising out of or related to the activities. The Participant(s) and I are physically fit and may participate in activities at The Play Room @ Rogue Pediatric Therapies, LLC and has not been advised to the contrary by a qualified medical professional.
I also assume all responsibility for supervising and monitoring the Participant(s).
I assume all responsibilities for supervising and monitoring my child/children while visiting The Play Room @ Rogue Pediatric Therapies, LLC.
I, for myself and the Participant(s) and our respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue The Play Room @ Rogue Pediatric Therapies, LLC and its managers, members, employees and/or other agents, for any injury to or death of the Participant(s) or myself arising, directly or indirectly, from participation in activities. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of The Play Room @ Rogue Pediatric Therapies, LLC and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract, or whether a COVID-19 infection occurs before, during, or after participation, or otherwise. I agree to indemnify and hold The Play Room @ Rogue Pediatric Therapies, LLC and its managers, members, employees and/or other agents harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any third party as a result of or arising out of my or the Participant’s involvement in activities and to reimburse The Play Room @ Rogue Pediatric Therapies, LLC for any such costs, expenses and fees as they are incurred.
I agree that my execution of this Waiver on the initial visit for the Participant(s) will authorize The Play Room @ Rogue Pediatric Therapies, LLC to enter this Waiver into its database and use it as a continuous, multi-use waiver for the Participant’s ongoing participation in activities. I hereby expressly authorize The Play Room @ Rogue Pediatric Therapies, LLC to use this Waiver as a multi-use waiver until such time as I revoke it in writing.
I hereby certify that I am the parent or legal guardian of the Participant(s) whose name appears above, and I have authority to waive rights on behalf of the minor Participant(s).
I have read and I understand all of the provisions of this document and the risks of activities. I acknowledge that I have read and understand the terms of this document and I am freely and voluntarily signing this document.
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTAND IT, AND I AGREE TO BE BOUND BY ITS TERMS.