To the moon and back Almonte Liability Waiver

IF YOU HAVE PREVIOUSLY FILLED A WAIVER OUT YOU DO NOT NEED TO DO ANOTHER FOR YOUR PLAY SESSION

Please fill out and submit this Liability Waiver Form if this is your first visit to our centre.

Waiver must be completed before entry to our play space.

For Birthday Parties and group bookings we only require your name/organisation. All people included in your visit will be inclusive of this waiver. Please provide adult organiser name and sign at the bottom.
Liability Waiver

Unit 1, 341 Frank Davis Street Almonte K0A 1X0
Parent/Guardian/Caregiver Information

IF YOU HAVE PREVIOUSLY FILLED A WAIVER OUT YOU DO NOT NEED TO DO ANOTHER FOR YOUR PLAY SESSION
Name

First NameLast Name
Email
example@example.com
Contact Information
Please enter a valid phone number.
Childs name

First NameLast Name
Additional Adult/Child

First NameLast Name
Additional Adult/Child

First NameLast Name
Additional Adult/Child

First NameLast Name
Date of Play Session or Birthday Party/Event

MonthDayYear
Date
Waiver
Participant Waiver and Agreement

I acknowledge that I have read and understand this waiver, and I certify that all personal information provided is correct. By participating in any activities at To The Moon and Back Almonte, I agree to the following terms:

Safety and Rules:

I will adhere to the posted safety signs, rules, and verbal instructions while participating in any party, program, or play area at To The Moon and Back Almonte.

I understand that there are inherent risks of injury, including scrapes, bruises, cuts, and more severe injuries such as paralysis or death, while engaging in activities at To The Moon and Back Almonte.

I acknowledge all risks involved, including those arising from the negligence of other participants.

Responsibility and Liability:

I assume full responsibility for any personal injury to myself and the listed minors, those attending under my organisation name as well as our respective heirs, assigns, administrators, personal representatives, and next of kin.

I waive, release, and discharge To The Moon and Back Almonte from any liability related to injuries or damages.

This waiver applies to all risks, known and unknown, even if resulting from negligent actions of other guests or employees.

I agree to pay for all damages caused by myself, children in my care including Birthday party guests.

Management reserves the right to ask anyone who is not following the rules of our playground to leave at any time.

Waiver Form:

Each participant must have a signed waiver form. If under 18, a parent/legal guardian or designated representative must sign on their behalf.
Without a signed waiver, participation in programs, parties, and use of play areas is prohibited.

Waiver forms are valid from January 1 2024 to December 31 2024. On the 1st January of a new calender year you will be required to fill out a new waiver.

Additional Rules:

Socks must be worn at all times.
Adults must supervise children.
Food must be consumed in the designated snack area, and all food must be peanut/nut-free.

Personal Items:

I will not hold To The Moon and Back responsible for any lost or stolen items I choose to bring into the building.

I attest that I am the parent or legal guardian of the minor(s) listed below or have received permission from their parent/legal guardian to execute this agreement on their behalf.
I confirm that the participants are healthy and physically capable of participating in all activities undertaken.
I consent to the use of photographs and videos for the use of marketing purposes on social media, websites and other sources.

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Liability Waiver

Parent/Guardian/Caregiver Information

Waiver