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KidZ Korner Party & Play

109 E 6th Street Corbin, KY 40701

606-361-1200

PLEASE READ THIS DOCUMENT CAREFULLY, IT AFFECTS YOUR LEGAL RIGHTS.

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. 

As parent or guardian of the child(ren) whose name is set forth below (who is referred to herein as the Participant(s)(s)”) and in consideration of the Participant(s)(s) being permitted to participate in the Activities (as defined below) conducted by , LLC its employees, managers, members or agents (“KIDZ KORNER”), the Participant(s)(s) and I agree as follows:

1.a. Activities -

The Participant(s) will participate in various activities offered by KIDZ KORNER (the "Activities”). Activities involve playground equipment, which can be dangerous and may expose me and my minor child/children to a variety of risks, dangers and hazards including, but not limited to: falling from heights; colliding with stationary objects, fixed structures, and other persons; the carelessness of Participant(s)s, and the failure of structures and other equipment. 


1.b. KIDZ KORNER and its employees will not be liable for contraction of any illnesses arising from participation at KidZ Korner Party&Play.

2. Assumption Of Risk -

I understand that the Activities entail the risk of severe bodily injury to the Participant(s). Injuries that could result will 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. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, for myself and the Participant(s) and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any injury arising out of or related to the Activities. 

3. Release, Discharge and Agreement Not To Sue -

I, for myself and the Participant(s) and our respective heirs, personal representatives and assigns, do hereby hold harmless and release, discharge and agree not to sue KidZ Korner Party&Play and its managers, members, employees and/or other agents, for any injury to or death of the Participant(s) 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 KidZ Korner Party&Play 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. 

4. Medical Expense -

My participation in this activity is purely voluntary and I elect to participate in spite of the risks. If I and/or my child are injured, I acknowledge that I and/or my child(ren) may require medical assistance, which I acknowledge will be at my and/or my child(ren)’s own expense or the expense of my personal insurer(s). I hereby represent and affirm that I and/or my child(ren) have adequate and appropriate insurance to provide coverage for such medical expense. I understand and agree that KIDZ KORNER will not pay for any cost or expenses incurred by me and/or my child(ren) if I and/or my child(ren) are injured. 

5. Indemnification And Hold Harmless –

I agree to indemnify KIDZ KORNER and hold KIDZ KORNER 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 third party as a result of or arising out of the Participant(s)'s involvement in the Activities and to reimburse KIDZ KORNER for any such costs, expenses and fees as they are incurred.

6. Parent Or Guardian Certification And Consent -

I hereby certify that I am the parent or guardian of the Participant(s) whose name appears 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. 

7. Compliance -

I agree that the Participant(s)s and I shall comply with all customary terms, posted safety signs, rules, and verbal instructions given by employees of KIDZ KORNER, as conditions for participation in Activities, and understand that failure to follow such rules and instructions may result in serious injury or death. In addition, if I observe any hazard during our participation in Activities, I will bring it to the attention of the nearest employee or representative immediately. 

8. Severability -

This document is intended to be as broad and inclusive as is permitted by the laws of the State of Kentucky and if any provision (or a part of any provision) contained herein is deemed to be invalid, the balance of the provisions shall continue in full legal force and effect, notwithstanding such invalidity. 

9. Media -

I further grant KIDZ KORNER the right, without reservation or limitation, to videotape, and/or record me and/or my child(ren) on closed circuit television without payment to the Participant(s) or parent/guardian. I further grant KIDZ KORNER the right, without reservation or limitation, to photograph, videotape, and/or record me and/or my child(ren) and to use my or my child(ren)’s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials. I would like to receive free email promotions and discounts to the email address provided below. I may unsubscribe from emails from KIDZ KORNER at any time. 


I HAVE READ AND UNDERSTAND THIS AGREEMENT AND SIGN IT FREELY, VOLUNTARILY, AND WITH KNOWLEDGE OF ITS CONTENTS, WITH THE INTENTION TO LEGALLY BOUND HEREBY. I AM AWARE THAT BY SIGNING THIS AGREEMENT, I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR THE PARTICIPANT(S), HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, AND/OR REPRESENTATIVES MAY HAVE AGAINST KIDZ KORNER



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
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*

Middle Name

Last Name*

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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