Complete a waiver for myself
Complete a waiver for myself and children
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Adult Information

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( Age must be at least 18 years old )

Contact Information

Participants

Waiver

Please read the waiver below and fill out the required fields found in the following form sections. All liability language from the waiver will apply to all persons listed below.

 

My Kidzplay

Indoor Playground Waiver of Liability / Assumption of Risk

Please read this entire waiver carefully as this is a legal binding document.

By signing this waiver, I am giving up my rights and the rights of my spouse and children and wards to sue MC Playgrounds Inc. DBA My Kidzplay for any injury, including paralysis or death, caused in whole or in part by the negligence or fault of My Kidzplay.

I further grant My Kidzplay the right, without reservation or limitation, to videotape, and or record me and/or my child(ren) and/or my wards on closed circuit television without compensation to me or my child(ren).

As consideration for being allowed to enter the indoor play area and/or Participate in any party, activity and/or program at My Kidzplay, the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified below, acknowledges, appreciates, understands, and agrees to the following:

  1.      I represent that I am the parent or legal guardian of the Participant(s) named below or I have obtained permission from the parent/legal guardian of the Participant(s) named below to execute this agreement on their behalf.
  2.       I acknowledge and understand that there are known and unknown risks associated with participation in My Kidzplay activities and the use of the play area and any and all My Kidzplay equipment, which include but are not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, sickness, disease or death.
  3.      I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS, which I also willingly assume.
  4.       I agree that the Participant(s) named, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any play event, parties or activities at My Kidzplay.
  5.      I, for myself, the Participant(s) named, our heirs, assigns, representatives, and next of kin agree to hold harmless, release, waive and indemnify the independent owner(s), members, their predecessors, parent, subsidiaries and affiliates, officers, equipment manufacturers, employees and sponsoring agencies from all liability for any such injury, disability, death or loss or damage to person or property to the fullest extent of the law.
  6.       I additionally agree to indemnify the independent owner(s), members, their predecessors, parent, subsidiaries and affiliates, officers, equipment manufacturers, employees and sponsoring agencies for any defense cost or expense arising from any and all claims, injuries, liabilities or damages arising from participation in any play event, parties or activities at My Kidzplay.
  7.      I am of physical ability to participate and am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion.
  8.       I understand that entry, by myself and the participant(s) named, constitutes consent for My Kidzplay to use any film, video, or likeness of participants for the purpose of marketing and promotional use, without payment to the participant. Such said purposes are but not limited to: Friends and Family Night, Grand Opening and Special Events.
  9.       We are committed to keeping your e-mail address confidential. We do not sell, rent, or lease our subscription lists to third parties, and we will not provide your personal information to any third-party individual, government agency, or company at any time unless compelled to do so by law. We will use your e-mail address solely to provide timely information and promotions about My Kidzplay.       
  10. The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision of this Agreement, which shall remain in full force and effect.
  11. Any controversy, dispute, or claim arising out of or related to this Agreement, which the parties are unable to resolve by mutual agreement, shall be settled exclusively by submission by either party of the controversy, claim or dispute to binding arbitration; said arbitration to take place exclusively before a single arbitrator located within 25 miles of the Event location and in accordance with the rules of the American Arbitration Association then in effect.  

By signing this waiver, I further acknowledge that I am at least 18 years old and accept the terms and conditions of this waiver, release, hold harmless and indemnification agreement as detailed in A through K above for any and all future visits during the next twelve (12) month period. Please keep this waiver, release, hold harmless and indemnification agreement on file and active, for the participants and parent/guardian listed above, for a period of twelve (12) months from the date of acceptance. 

By signing this waiver, I further acknowledge that My Kidzplay reserves the right to communicate with its guests via mobile marketing & email marketing. By giving your phone number in this waiver, you agree to receiving mobile communication from My Kidzplay. This communication can include special marketing offers from My Kidzplay, announcements, updates about the business and anything else we feel is pertinent to our business. We will never sell, rent, or give away our mobile list to outside businesses. 

 

Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death. 

My Kidzplay cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing My Kidzplay services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize My Kidzplay’s services and/or enter onto My Kidzplay’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. 

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize [name of company]’s services and enter My Kidzplay’s premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize My Kidzplay’s services and premises in person. 

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against My Kidzplay and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing My Kidzplay’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. CHOICE OF LAW: I understand and agree that the law of the State of Illinois will apply to this contract. 

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND BY SIGNING BELOW I FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE. I FURTHER ACKNOWLEDGE THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR(S) NAMED ON THIS WAIVER. I HAVE LEGAL RIGHT TO CONSENT TO AND, BY SIGNING BELOW, I HEREBY DO CONSENT TO THE TERMS AND CONDITIONS OF THIS RELEASE FOR SAID MINORS.

 

 

 



I acknowledge I have read and understand this waiver and certify that all personal information is correct.
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