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AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

This form covers all classes and/or programs offered by Motor Skills Indoor Playground, LLC

Please fill out the following, being sure to read and initial each paragraph.


I,

, hereby agree to the following:

That I am participating in group play classes or other programs offered by Motor Skills Indoor Playground LLC during which I receive education, information and instruction about exercise, wellness and prevention. I recognize that these group play classes and programs may require physical exertion, which may be strenuous. I understand parent supervision is required for my child(ren) during group play classes or other programs and/or activities. Although unlikely, physical injury could occur. I am fully aware of the risks and hazards involved and I agree to assume any responsibility for my child’s injury. I will follow all instructions and modifications recommended by Motor Skills Indoor Playground. 

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in group play classes and/or programs. I represent and warrant that my child is physically able to participate in exercises classes and I have no medical condition that would prevent my child from full participation in these group physical exercise classes and/or programs.

I have read and understand the Exercise Guidelines for participation in Group Exercise classes. 


 

I agree to inform Motor Skills Indoor Playground of any physical limitations, physical discomforts and/or injuries before or during fitness classes and/or programs, and I take full responsibility for nondisclosure. 



I have read the above release waiver of liability and fully understand its contents. 



I voluntarily agree to its contents. I voluntarily agree to the terms and conditions stated above. 


Name/Signature:

Date: December 22, 2024

First  Name

First Name*

Last Name*
First  Date of Birth*
First  Signature*
Second Name

First Name*

Last Name*
Second Date of Birth*
Third Name

First Name*

Last Name*
Third Date of Birth*
Fourth Name

First Name*

Last Name*
Fourth Date of Birth*
Fifth Name

First Name*

Last Name*
Fifth Date of Birth*
Sixth Name

First Name*

Last Name*
Sixth Date of Birth*
Seventh Name

First Name*

Last Name*
Seventh Date of Birth*
Eighth Name

First Name*

Last Name*
Eighth Date of Birth*
Ninth Name

First Name*

Last Name*
Ninth Date of Birth*
Tenth Name

First Name*

Last Name*
Tenth Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Photo Release
Please note that photographs and footage may be taken during classes and events for marketing and publicity in our publications, on our website and in social media or in any third party publication. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent, or legal guardian. Please indicate below if you wish to be exempted from this activity. *
I hereby grant permission to Motor Skills Indoor Playground to use photographs and/or video of all participants in my party in publications, news releases, online, and in other communications related to the mission of Motor Skills Indoor Playground.
I request to be exempt from photographs and/or video of all participants in my party for publications, news releases, online, and in other communications related to the mission of Motor Skills Indoor Playground.
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*

Relationship*

Phone*
Parent or Guardian's 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.


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