Loading...

Creek House Playground Liability Waiver


I hereby acknowledge and agree to the following terms and conditions related to my use, and if applicable, my child's use, of a private Playground (hereinafter referred to as "the Playground"), owned by the Philpott Descendants Corporation, located on the property with an address at 1455 Philpott Dr, Bassett, VA 24055.

1. Waiver for Personal Use. I hereby waive any and all claims, demands, actions, causes of action, or suits (collectively referred to as "Claims") against the Philpott Descendants Corporation, its shareholders, officers, and directors, arising from or in connection with my personal use of the Playground, and if applicable, my child's use. 

I Agree
 

2. Acknowledgment of Risks. I understand and acknowledge that the use of the Playground involves inherent risks, including the risk of injuries, serious injuries, or even death. I understand and acknowledge that the Playground is not an engineered or safety-certified structure. I fully understand and accept that the Philpott Descendants Corporation is not responsible for providing adult supervision for the Playground. 

I Agree
 

3. Release of Liability. I hereby release and discharge the Philpott Descendants Corporation, its shareholders, officers, and directors from any and all liability for any damages, injuries, losses, or expenses that may arise from my use, and if applicable, my child's use of the Playground equipment.

I Agree
 

4. Insurance Coverage. I affirm that I currently possess and will continue to maintain proper hospitalization, health, and accident insurance coverage, which I consider adequate for my own protection, and if applicable, my child's protection, while using the Playground. 

I Agree
 

5. Voluntary Agreement. I have read this acknowledgment of risk and waiver of liability thoroughly and understand its contents and intent. I voluntarily sign this form, acknowledging that I am assuming all risks associated with the use of the Playground, for myself and if applicable, my child.

I Agree
 

By signing below, I hereby acknowledge that I have read, understood, and agreed to the terms and conditions outlined in this Creek House Playground Liability Waiver.


First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!