• Participant Waiver, Release, Assumption of Risk, and Indemnification Agreement

    Complete the participant and minor details, review the agreement sections, and provide your signature to consent and release claims.
  • This Waiver, Release, Assumption of Risk, and Indemnification Agreement ("Release") is voluntarily executed by the parent named below, as signed on today's date. This release pertains to the use of the facilities at The Village Playspace and its affiliates, agents, owners, officers, managers, shareholders, affiliates, volunteers, participants, employees, assigns, and all other persons or entities acting in any capacity on its respective or collective behalf (collectively referred to herein as "Releasees").

  • Format: (000) 000-0000.
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  • Number of Minors Participating*
  • Minor 1 - Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Minor 2 - Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Minor 3 - Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Minor 4 - Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • General Release

    I acknowledge and agree that this Release covers and is intended to release and provide other benefits, legal protections, and consideration to Releasees as it pertains to any claims that arise at the Releasees facility ("The Village Playspace LLC") or the attractions at The Village Playspace Facility ("The Village Playspace Attractions"). I agree to accept and assume all of the risks existing in The Village Playspace Attractions and Facilities, both known and unknown, either caused or alleged to be caused by the negligent acts or omissions of Releasees. I further acknowledge that I have been provided and am wearing the custom gripper socks required to use the attractions. My participation is purely voluntary, and I elect to participate in spite of the risks. I voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from and against any and all damages, actions, claims, suits, demand actions, and liabilities, whether known or unknown, anticipated, suspected or unsuspected, now or any time in the future, in any way relating to or arising from any activity, occurrence, or event, whether supervised or not, including, without limitation, all claims for property damage, personal injuries, or wrongful death involving Releasees, including claims that allege negligent acts or omissions with the exception of gross negligence, or intentional, willful or wanton misconduct. I further agree that I am solely responsible for my personal property while at The Village Playspace facility; The Village Playspace and its personnel assume no responsibility for any lost or stolen personal property.

  • Release of Potential Injuries for Attractions

    I acknowledge and agree that the children in my care, and my invited guests who will participate in any activities at Releasees are physically, mentally, and emotionally fit to participate in such activities. I further understand that no one adult or guardian shall bring more than four children. I agree that there are risks, both known and unknown, when using The Village Playspace Facilities and that the use of said facilities, or observation of others using them, has inherent and obvious dangers. These risks include serious physical or emotional injury, infection with disease or viruses, paralysis, death, damage to myself and/or third parties, and may include damage to personal property of any or all such persons. I understand that these risks are inherent in the essential qualities of the activities and cannot be removed without substantially changing the activity. I understand that these activities are for recreational purposes and completely voluntary. I also agree to use The Village Playspace Facilities in a safe and responsible manner. Further, I agree and understand that participating in these activities while under the influence of drugs, prescription or illegal, and/or alcohol significantly increases the above risks and I assume any risk of participating while under the influence of any drugs and/or alcohol.

  • Release of Potential Infection of Disease and Viruses

    I acknowledge that The Village Playspace Facility is a public location with many guests and employees who utilize the space on a daily basis. I further recognize that while Releasees practice appropriate and reasonable cleaning practices, I could still potentially get infected with a disease or virus, including, but not limited to, COVID-19, through my participation in, or observation of others participating in activities at The Village Playspace. I fully release Releasees from any claim against them regarding the contraction of a disease or virus for myself or the Child. I attest that: I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. I have not traveled internationally within the last 15 days. I have not traveled to a highly impacted area within the United States of America in the last 15 days. I do not believe and have no knowledge that I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19 in the last 15 days. I have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities. I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

  • Agreement to Pay My Own Medical Expenses

    I acknowledge, accept, and assume the risk of any and all medical conditions, limitations, or disabilities (whether temporary or permanent) that I or the Child possess, whether known or unknown, which might contribute to or exacerbate any injury or illness that I or the Child might sustain as a result of using The Village Playspace facilities. I acknowledge and agree that if medical assistance of any form is required or performed as a result of any injury I or the Child sustains while using The Village Playspace facilities, such assistance shall be at my own expense.

  • Photo, Video & Social Media Waiver

    In connection with my and the Child's use of The Village Playspace Facilities and Attractions, I consent to the recording of the Child's and my physical likeness and/or voice through mechanical, photographic, technical, digital, electronic, or other means ("Recordings"). I hereby consent to and authorize Releasees to use, in perpetuity, such Recordings, as well as the Child's name and my name, for any purpose, including advertising, promoting, exploiting and/or publicizing The Village Playspace Facility. I waive any and all claims that I or the Child may have in connection with the Recordings. If an image of your child is published or re-shared on social media and you do not wish for your child's image to be shared, please notify management at hello@thevillageplayspace.com and the image will be removed accordingly.

  • Right to Refuse Entry

    The Village Playspace reserves the right to refuse access to any area of the facility if Child(ren) or Guardians are engaging in disruptive and/or hazardous behavior or are under the influence of drugs or alcohol, or if the managing employee determines that the individual poses a risk to the safety of others. Refusal of service due to these circumstances shall not entitle the Client to any refund of booking fees.

  • PARENT OR GUARDIAN CONSENT

    I have read and understand the terms of this Agreement and unconditionally agree to its full terms, statements, warranties, notices, representations, waivers, and releases on behalf of both myself and my child or ward. All such terms fully apply to my child or ward as if I was the participant. I understand that by signing this Consent, I am giving up important legal rights both on behalf of myself and the Child regarding potential rights and claims against Releasees. I have had sufficient opportunity to read this entire document, and I agree to be bound by its terms. By signing below, I certify that I am the parent or legal guardian, supervisor, or responsible person for the child(ren) for whom I am signing, or that I have the express permission of the parent or legal guardian. I understand that this is a permanent waiver to be kept on file by The Village Playspace for today's visit and all future visits.

  • PARENT OR GUARDIAN INDEMNIFICATION

    AS THE INDIVIDUAL SIGNING THIS AGREEMENT ON BEHALF OF A MINOR OR OTHER INDIVIDUAL, I AGREE TO FULLY INDEMNIFY AND HOLD RELEASEES HARMLESS FOR ANY AND ALL CLAIMS CONNECTED WITH, ARISING OUT OF, OR RESULTING FROM THE INDIVIDUAL OR THE CHILD'S USE OF THE VILLAGE PLAYSPACE FACILITIES OR ATTRACTIONS. BY SIGNING THIS DOCUMENT, I REPRESENT THAT I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY OR THE CHILD'S LOSS, DAMAGE, OR INJURY, INCLUDING DEATH, WHETHER OR NOT KNOWN OR ANTICIPATED, THAT OCCUR WHILE ON THE PREMISES OF RELEASEES. I FURTHER AGREE TO INDEMNIFY RELEASEES FOR ANY LIABILITY FOR ANY INJURY, DAMAGE OR LOSSES OF ANY KIND CAUSED BY MY NEGLIGENT OR INTENTIONAL ACTS WHILE ON THE PREMISES. THE SIGNATURE BELOW IS PROOF OF MY INTENTION TO EXECUTE A COMPLETE AND UNCONDITIONAL WAIVER, RELEASE, AND INDEMNIFICATION OF ALL LIABILITY TO THE FULL EXTENT OF THE LAW.

  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
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