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WHIMSY PINES FARM LLC

AGRITOURISM LIABILITY WAIVER & RELEASE OF LIABILITY

6670 Red House Road, Appomattox, VA 24522

VOLUNTARY PARTICIPATION

I understand that I (and/or the minor child(ren) in my care) am voluntarily participating in activities at Whimsy Pines Farm LLC, an agritourism and recreational farm environment.

Activities may include, but are not limited to:

Bounce houses and inflatable obstacle courses

Creek access and rope swings

Climbing equipment (nets, domes, ropes, structures)

Slides and playground equipment

Sand play areas

Petting zoo and interaction with farm animals

Walking trails and general outdoor recreation      


ACTIVITY-SPECIFIC ACKNOWLEDGMENTS (INITIAL EACH LINE)

Bounce Houses & Inflatables –

I Agree

I understand that risks include, but are not limited to: falling while jumping or exiting, being knocked down or landed on by other participants, collisions with walls or other children, flipping or improper use, landing on hard surfaces, sprains, fractures, head injuries, neck injuries, and injuries caused by overcrowding or loss of balance. 

Creek, Water Areas & Rope Swings –

I Agree

I understand that risks include, but are not limited to: slipping on wet rocks or mud, falling into shallow or deep water, drowning, being pulled by current, striking rocks or the creek bed, rope swing failure or loss of grip, falling from height into water or onto land, hypothermia, and waterborne hazards.

Slides and Playground Equipment –

I Agree

I understand that risks include, but are not limited to: falling off equipment, slipping while climbing, collisions on the slide or at the bottom of slides, improper use (headfirst sliding, overcrowding), impact injuries, and injuries caused by uneven landings. 

Climbing Equipment (Nets, Domes, Ropes, Structures)–

I Agree

I understand that risks include, but are not limited to: falling from elevated surfaces, loss of grip, entanglement in ropes or nets, collisions with other participants, impact with the ground or structure, cuts, bruises, trains, and serious injury from height.

Sand Play –

I Agree

I understand that risks include, but are not limited to: cuts, scrapes, splinters, debris hidden in sand, sand entering eyes, nose, or mouth, irritation, and injuries from toys or rough play.

Animals –

I Agree

I understand that risks include, but are not limited to: being bitten, kicked, stepped on, head-butted, scratched, or knocked over by animals; unpredictable animal behavior; allergic reactions; exposure to bacteria or disease; and injury caused by improper feeding or handling of animals. 

General Farm Environment –

I Agree

I understand that risks include, but are not limited to: uneven ground, holes, rocks, roots, mud, slipping or tripping, insect bites or stings (including bees, wasps, and ticks), exposure to poison ivy or other plants, extreme weather (heat, cold, rain, wind), sunburn, dehydration, and contact with farm tools, fencing, or natural hazards

I also understand that natural outdoor environments may include falling branches, falling trees, or tree limb failure, especially during wind, storms, or changing conditions, which may result in serious injury or death. 

ASSUMPTION OF RISK

I understand that agritourism and outdoor recreational activities involve inherent risks that cannot be eliminated. I voluntarily assume all risks of injury, illness, death, or property damage arising from participation, whether caused by environmental conditions, equipment, animals, or other participants.

I Agree

RELEASE OF LIABILITY

To the fullest extent permitted by Virginia law, I release, waive, and discharge Whimsy Pines Farm LLC, its owners, employees, volunteers, and agents from any and all liability for injuries, damages, or losses arising from participation, including those caused by ordinary negligence.

I understand this release does not apply to gross negligence, willful misconduct, or violations of law. 

I Agree

GUARDIAN RESPONSIBILITY

I certify that I am the parent, legal guardian, or responsible adult for any minor listed below.

I understand:

I am signing on behalf of any minor (under 18) in my care, whether I am their parent or not

I accept full responsibility for their supervision, behavior, and safety

I assume all risks on their behalf

I release Whimsy Pines Farm LLC from liability on behalf of myself and all minors listed

I affirm that I have authority to sign for each minor. 

I Agree

CLOSURES & REFUND POLICY

 I understand that Whimsy Pines Farm LLC operates outdoors and conditions may change.

I acknowledge:

The farm may close, delay, or end operations early at any time

Attractions may be closed or restricted for safety

Decisions are made at the sole discretion of Whimsy Pines Farm LLC

I agree that no refunds will be given due to:

Weather conditions

Partial closures

Attraction shutdowns

Early closure

I Agree

INFLATABLE WIND POLICY

I understand that inflatable equipment is highly sensitive to weather.

I acknowledge:

Bounce houses may be shut down immediately due to wind, rain, or unsafe conditions

Wind may cause inflatables to shift, tip, or become dangerous

I must exit immediately when instructed

I agree that no refunds will be given due to inflatable closures. 

I Agree

MEDICAL AUTHORIZATION

 In the event of injury or emergency, I authorize Whimsy Pines Farm LLC to seek medical treatment.

I understand:

I am responsible for all medical costs

Staff are not medical professionals

I Agree

RULES

 I agree to follow all posted rules and staff instructions.

I understand:

Children must be supervised at all times

Unsafe behavior may result in removal without refund

I am responsible for all individuals in my care

I Agree

PHOTO RELEASE

I grant permission for Whimsy Pines Farm LLC to use photos or videos taken during visits for marketing and promotional purposes without compensation. 

I Agree

FINAL AGREEMENT

 If any portion of this agreement is found invalid, the remaining portions shall remain in full force and effect.

.

I Agree

ACKNOWLEDGMENT

I have read and understand this agreement.

I sign it freely and voluntarily.

I understand that I am giving up certain legal rights.

I understand and agree that this agreement is valid for all visits to Whimsy Pines Farm LLC for a period of one (1) year from the date of signing, unless a new agreement is required due to updated terms, activities, policies, or new minors.

I Agree

Date: April 13, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
MEDICAL CONDITIONS
No conditions
OR list below
If have any MEDICAL CONDITIONS please list:
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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