Kalisi Kids Play Waiver Form

Parent or guardian *

First NameLast Name

Contact Phone Number*

Please enter a valid phone number.

Emergency contact*

First NameLast Name

Emergency contact phone number *

Please enter a valid phone number.

Email Address*

example@example.com

Number of Children

Child’s name *

First NameLast Name

Child birthday *

Date

Child’s name

First NameLast Name

Child’s birthday

Date

Child’s name

First NameLast Name

Child’s birthday

Date

Please list any medical conditions *

Rules and Policies*

Please read and acknowledge the following rules for the Kalisi Café Children’s Play Area. These rules are in place to ensure the safety and enjoyment of all guests. 1. Parental Supervision: • Parents or guardians are responsible for supervising their children at all times while in the play area. • No child under the age of 12 may be left unattended in the play area or café premises. • Parents/guardians must remain within the play area or café and be readily available to attend to their child(ren). 2. No Phones in Play Area: • For safety and privacy reasons, the use of mobile phones, cameras, or other recording devices is strictly prohibited in the play area. • Phones may be used in designated café seating areas outside the play area. 3. No Shoes, Socks Required: • No shoes or bare feet are permitted in the play area. All children and adults must wear socks at all times. • If socks are forgotten, they can be purchased at the front café counter for $2 per pair. 4. Play Bin Responsibility: • Play bins (containing toys or activities) must be signed out at the front café counter by a parent/guardian. • Parents/guardians are responsible for ensuring all play bins and their contents are returned in good condition before leaving the play area. • Any missing or damaged items may result in a replacement fee. 5. Responsibility for Damages: • Parents/guardians are responsible for any damages to the play area equipment, play bins, café property, or other guests’ belongings caused by their child(ren) or themselves. • Kalisi Café reserves the right to seek compensation for repairs or replacements resulting from intentional or negligent damage. 6. General Conduct: • Children and parents/guardians must follow all posted rules and staff instructions. • Aggressive behavior, bullying, or unsafe actions will result in immediate removal from the play area without refund. 7. Health and Safety: • Children who are unwell (e.g., fever, contagious illnesses) are not permitted in the play area. • Food and drinks are not allowed in the play area.Acknowledgment: I have read, understood, and agree to abide by the above rules and policies.

Assumption of Risk and Liability Waiver:

I, First Name* Last Name* on behalf of myself and my child(ren) listed above, acknowledge and agree to the following: 1. Assumption of Risk: • I understand that participation in the Kalisi Café Children’s Play Area involves inherent risks, including but not limited to falls, collisions, or injuries from equipment or play bin use. • I acknowledge that these risks cannot be entirely eliminated, and I voluntarily assume all risks associated with my child(ren)’s participation. 2. Release of Liability: • In consideration of being permitted to use the play area, I, for myself, my child(ren), and our heirs, executors, and assigns, hereby release and discharge Kalisi Café, its owners, employees, agents, and affiliates (collectively, the “Released Parties”) from any and all claims, demands, or causes of action arising from any injury, loss, or damage to person or property sustained in connection with the use of the play area, whether caused by the negligence of the Released Parties or otherwise, to the fullest extent permitted by law. 3. Indemnification: • I agree to indemnify and hold harmless the Released Parties from any claims, liabilities, or expenses (including legal fees) arising from my child(ren)’s actions, including but not limited to injuries to other persons or damage to property. 4. Medical Authorization: • In the event of an emergency, I authorize Kalisi Café staff to seek medical treatment for my child(ren) if I cannot be reached. I understand that I will be responsible for any associated medical costs.

Photo or video release *

Play Area Policies and Acknowledgments- I understand that Kalisi Kids:Kalisi Cafe is NOT a peanut-free facility. Peanuts and other allergens may be present, and I assume all risks related to allergies for my child.- I acknowledge that no outside food or beverages are permitted in the play area. All food must be purchased from our on-site café (if applicable).*

Kalisi Cafe, including our Kalisi Kids program, we provide a small trampoline for recreational enjoyment. Trampoline use involves inherent risks, including falls, collisions, or injuries. All users must follow posted safety rules and staff instructions. By signing this waiver, you assume all risks associated with trampoline use and release Kalisi Cafe, Kalisi Kids, and all affiliates from liability for any injuries or damages that may occur.*

Signature*

By filling out this form and submitting you agree to all the terms and conditions listed above. Please write I agree along with your full name.

Kalisi’s Play Area/Outdoor play Waiver Form