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New Client Play Waiver


 In Consideration of being allowed to enter the play area/or participate in any party and/or program at Mad Hatter 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 Mad Hatter Play Cafe. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Mad Hatter 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 Mad Hatter 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, Mad Hatter Play Cafe LLC, and Mad Hatter 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 Mad Hatter 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 of

(2 years and under) enter the labeled gated area, refraining from running, and refraining from throwing or misusing toys in any way. I also 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 Mad Hatter 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 Mad Hatter Play Cafe 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. Mad Hatter Play Cafe LLC has put in place preventative measures to reduce the spread of COVID-19; however, Mad Hatter Play Cafe LLC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Mad Hatter 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 Mad Hatter 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 Mad Hatter Play Cafe may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Mad Hatter 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 Mad Hatter Play Cafe programming. On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Mad Hatter 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 Mad Hatter Play Cafe, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Mad Hatter Play Cafe programs.


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 Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's 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*

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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