Release of Liability and Waiver Form In exchange for participation in the activity of indoor play organized by The Big Backyard, LLC, I agree for myself and (if applicable) for the members of my family, to the following conditions: ____ 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. I further represent that the participants are healthy and physically able to participate in any and all undertaken activities. ____ I agree that the participant(s) named below and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for play and participation in any party and/or program at The Big Backyard, LLC. I agree to pay for all damages to the facilities of The Big Backyard, LLC caused by my or my family’s negligent, reckless, or willful actions. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest The Big Backyard, LLC employee or official immediately. ____ I recognize that there are certain inherent risks associated with use of the play area, parties, and programs and I assume full responsibility for personal injury to myself and (if applicable) my family members. I, for myself and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, waive, release and discharge The Big Backyard, LLC, its affiliates, officers, members, agents, employees, other participants, and sponsoring agencies for injury, loss or damage arising out of or related to our participation in any and all of The Big Backyard, LLC programs, activities, parties, and/or the use of the the facilities of The Big Backyard, LLC. This waiver and release shall apply to all risks, known and unknown, even if resulting from negligent actions of other guests or employees of The Big Backyard, LLC. Signature of Parent/Legal Guardian____________________________________________________________________ Date________________________________________ Parent’s Name________________________________________________________ Child’s Name__________________________________ Birthday_______________ Address______________________________________________________________ Child’s Name__________________________________ Birthday_______________ Emergency Phone_____________________________________________________ Child’s Name__________________________________ Birthday_______________ E-Mail (optional)______________________________________________________ Child’s Name__________________________________ Birthday_______________ I do not wish to be added to The Big Backyard’s mailing list.
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