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In Consideration of being allowed to enter the play area and/or participate in any party and/or program at Play/Cafe, the undersigned, on his or her behalf, and on the behalf of the participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:

I represent that I am the parent or legal guardian of the participant(s) named, or I have obtained permission from the parent/legal guardian of the participant(s) named to execute this agreement on their behalf. 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 party and/or program at Play/Cafe. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Play/Cafe employee or official immediately. I understand that I am responsible for my child’s safety and behavior at all times each visit. I understand that I am responsible for monitoring the participant(s) named during the entirety of our visit;

I am aware that there are inherent risks associated with participation in Play/Cafe programs and parties and I, on behalf of myself and the participant(s) named on the reverse, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants;

I, for myself and the participant(s) named, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, Play Cafe LLC, and Play/Cafe management, their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our participation in any and all Play/Cafe programs, activities, parties, and the use of the play area;

I, for myself and the participant(s) named, will read and abide by all posted rules, including, but not limited to: wearing socks inside of the play area, ensuring only children within the age limit (18 months and under) enter the labeled and gated baby area, refraining from running, and refraining from throwing or misusing toys in any way. I also understand that there is absolutely no food allowed inside of the play area at any time. I understand that in order to play, my child must be well and free of any communicable/contagious illness;

NOTE: We reserve the right to deny service to any child or adult who may appear ill, and require a doctor’s note for any ill child to return. We also reserve the right to ask any guest who does not adhere to this signed agreement to leave without refund, and;

I grant permission to Play Cafe LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Play Cafe LLC and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that are given at the facility, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.


Assumption of the Risk and 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 extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Play Cafe LLC has put in place preventative measures to reduce the spread of COVID-19; however, Play Cafe LLC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Play/Cafe could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Play/Cafe and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Play/Cafe may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Play/Cafe employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance or participation in Play/Cafe programming. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Play Cafe LLC, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Play/Cafe, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Play/Cafe program.

By submitting this form, you acknowledge and agree that you are affixing your electronic signature to this document. The parties agree that the electronic signature of a party to this Agreement shall be as valid as an original signature and shall be effective to bind such party to this Agreement.


First Adult's Name

First Name*

Last Name*

Phone*
First Adult's Age Acknowledgment*
First Adult's Date of Birth*
I certify that I am 18 years of age or older
First Adult's Signature*
Second Adult's Name

First Name*

Last Name*
Second Adult's Date of Birth*
Third Adult's Name

First Name*

Last Name*
Third Adult's Date of Birth*
Fourth Adult's Name

First Name*

Last Name*
Fourth Adult's Date of Birth*
Fifth Adult's Name

First Name*

Last Name*
Fifth Adult's Date of Birth*
Sixth Adult's Name

First Name*

Last Name*
Sixth Adult's Date of Birth*
Seventh Adult's Name

First Name*

Last Name*
Seventh Adult's Date of Birth*
Eighth Adult's Name

First Name*

Last Name*
Eighth Adult's Date of Birth*
Ninth Adult's Name

First Name*

Last Name*
Ninth Adult's Date of Birth*
Tenth Adult's Name

First Name*

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

Email*

Confirm Email*
I'd like to receive information, news, and discounts by e-mail.
My Responsibilities
When I have minor(s) with me, I agree to monitor them at all times. I understand that it is MY responsibility to remind minor(s) of Play/Cafe rules (NOT the responsibility of Play/Cafe staff) therefore I will always sit/stand where I have a clear view of the minor(s) unless another adult customer is explicitly appointed with this duty. As the couches outside of the play area do not provide adequate line-of-sight, I will sit on them ONLY if another adult has been appointed to monitor minor(s). *
I agree
I will remind minor(s) whenever necessary to use walking feet (no tag or chasing games). *
I agree
I will remind minor(s) to play gently with Play/Cafe toys and materials so they can last a long time. *
I agree
I will not eat or serve any outside food or drinks (other than baby food) during open-play hours.
I agree

Parent(s) or Guardian(s) or Caregiver(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 Guardian or Caregiver agrees that they are also subject to all the terms of this document, as set forth above.

Parent, Guardian, or Caregiver's Name

First Name*

Last Name*

Relationship*

Phone*
Parent, Guardian, or Caregiver's Age Acknowledgment*
Parent, Guardian, or Caregiver's Date of Birth*
I certify that I am 18 years of age or older
Parent, Guardian, or Caregiver'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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