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Release of Liability

TODAY'S DATE: June 13, 2021

In consideration of being a willing participant in any party or open play at The Playground For Kids LLC in Ankeny, Iowa. The participants and or guardians signed on this waiver agree to the following:
I understand and acknowledge that the activity which I am or/and (any minor children for which I am the parent, legal guardian, or otherwise responsible, any heirs personal representative) about to voluntarily engage in as a participant and/or volunteer bears certain known risks and unanticipated risks could result in injury, death, illness or disease, physical or mental, or damage to myself, or to spectators or third-parties. I, being aware of this activity entails risk or injuries to myself (and any minor children for which I am the parent, legal guardian, or otherwise responsible, any heirs, personal representative, or assigns) expressly agree, covenant and promise to accept and assume all responsibility and risk for injury, death, illness or disease, or damage to myself (and any minor children for which I am the parent, legal guardian, or otherwise responsible, any heirs, personal representative, or assigns) participation in this activity is purely voluntary; no one is forcing me to participate, and I elect to participate in spite of the known and unknown risks. Release: In consideration of the services provided, I, for myself and any minor children for which I am the parent, legal guardian, or otherwise responsible, any heirs, personal representatives or assigns, do herby release The Playground For Kids LLC, its principals, directors, officers, agents, employees and volunteers from any liability and waive claim for damages arising from any cause whatsoever (except that which is gross negligence). I further agree to reimburse you all attorney fees and costs should I bring legal action against you and lose.
Severability: If any part of this agreement is held unenforceable, the rest of this agreement will continue in effect.

First Participant's Name

First Name*

Last Name*
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*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
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.
Parent or Guardian's Name

First Name*

Last Name*
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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