Bounce House Permission Slip
Or HaOlam Messianic Synagogue Etz Chaim Academy
Parent/Guardian Name
First Name
Last Name
Child Name
First Name
Last Name
I, undersigned, agree with the following statements:
I am the parent/guardian of the child stated above.
I voluntarily elect for my child to participate in playing in the bounce house.
I fully understand this involves jumping on an air filled entertainment toy, bounce house.
I fully understand the health and safety risks associated with these types of activities. I, therefore, assume all risk of injury associated with this event. I will not hold Or HaOlam Messianic Synagogue/Etz Chaim Academy, its agents, owners, shareholders, employees, or anyone affiliated with its Management, liable for any circumstances of this event.
I hereby confirm that my child is in good physical condition and does not suffer from any disabilities or physical conditions that place him/her or others at risk or otherwise physically inhibit participation in this event.
By this waiver and release, I acknowledge that I have read, understand, and fully agree to the terms of this waiver and release and its contents. My signature is proof of my intent to execute a complete and unconditional waiver and release of all liabilities in force under the law.
Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: