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Waiver Form

Participation Agreement, Liability Waiver, and Hold Harmless Agreement

I, and as parent or legal guardian of the child (or children) whose name is set forth below (each referred to as a “Participant” and collectively referred to herein as the “Participants”) and in consideration of the Participants being permitted to participate in the Activities (as defined below) conducted by The Cub House Play Café LLC, located at 1621 NC Hwy 42 West, Clayton, NC 27520 (“The Cub House Play Cafe”) agree as follows:

1. Activities – Activities shall be defined as the various activities and services offered to Participants by The Cub House Play Cafe, an indoor playground and cafe.

2. I understand that the employees of The Cub House Play Cafe, LLC are not responsible for Participants who utilize the space, and it is the responsibility of the undersigned individual to supervise any minors they bring into the facility.

3. I, and the children under my care, understand and agree to the safety rules and play guidelines as outlined on cubhouseplayspace.com. I acknowledge that these rules and guidelines may change and that I have read and am familiar with them prior to entering the play space and making use of the facility.

4. COVID-19 WARNING. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are extremely vulnerable.

BY VISITING THE CUB HOUSE PLAY CAFÉ LLC, YOU VOLUNTARILY ASSUME ALL RISKS RELATED TO COVID-19.

5. ASSUMPTION OF RISK – In addition to the inherent risk of exposure to COVID-19, I also understand that the Activities entail the risk of severe bodily injury to the Participants. Injuries that could result may vary but may include (a) minor injuries such as scratches, bruises and sprains; (b) major injuries such as eye injury or loss of sight, joint or back injuries and concussions; and (c) catastrophic injuries, including paralysis and even death.

I understand that The Cub House Play Cafe cannot eliminate all risks or guarantee the safety of the Participants while Participants participate in the Activities. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly on behalf of myself and my minor Participant child. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, for myself and any minor Participant child, and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any sickness or injury arising out of or related to the Activities.

6. RELEASE, DISCHARGE & AGREEMENT NOT TO SUE – I, for myself and any minor Participant child and our respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue The Cub House Play Cafe or its managers, members, employees and/or other agents, for any sickness, injury to or death of any Participant arising, directly or indirectly, from participation in the Activities. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of The Cub House Play Café and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract or otherwise.

7. Indemnification And Hold Harmless – I agree to indemnify The Cub House Play Cafe and hold The Cub House Play Cafe harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any party as a result of or arising out of my or my minor Participant child’s involvement in the Activities and agree to reimburse The Cub House Play Cafe for any such costs, expenses and fees as they are incurred.

8. Security Cameras. I understand that security cameras installed around and within The Cub House Play Café’s facility are for the safety of all participants and may be referenced should any incidents or injury occur.

9. Photo Release. I grant The Cub House Play Cafe permission to use any photographs, video, or sound bites obtained of me or any minor Participant child at The Cub House Play Café’s facility for any legal use including but not limited to: publicity, advertisement and web content. I understand that no royalty or other compensation shall be payable to me or the minor Participant by reason of such use.

10. Parent or Legal Guardian Certification and Consent – I hereby certify that I am the parent or legal guardian of the minor Participant children whose name(s) appear below, and I have authority to waive rights on behalf of the minor Participant(s). I have read and I understand all of the provisions of this document and the risks of the Activities. I understand that the Activities could cause injury and even death. I acknowledge that I have read and understand the terms of this document and I am freely and voluntarily signing this document. This Participation Agreement, Liability Waiver, and Hold Harmless Agreement has no expiration date.

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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