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We require a waiver signed for each child. If you have completed a waiver since June 13, 2016 please proceed to the front desk.

Release from Liability, Waiver of Claims, Likeness Release, and Indemnification Agreement

In consideration of the undersigned and any minor children listed below (collectively, the Participants) receiving permission to participate in the activities offered by Bounce, Play-n-Create, LLC, including, but not limited to, being present at, and the use of the equipment, facilities, and programs of, the family entertainment center operated by Bounce, Play-n-Create, LLC (the Facility), which contains and offers inflatable bounce houses and other inflatable play equipment, indoor playground equipment, climbing toys and equipment, games, parties, art activities, camps, classes and other programs, toddler play area, and toys (collectively, the Activities), the undersigned, on behalf of the undersigned, the other Participants, and the heirs, executors, administrators, legal representatives, successors, and assigns of all Participants (collectively, the Releasors), hereby agrees as follows:

The undersigned certifies that: (a) the undersigned is the parent or legal guardian of the minor Participants named below or has been granted a power of attorney from the parent or legal guardian of the minor Participants named below to execute this agreement on their behalf; (b) the undersigned will familiarize all Participants with the rules and conditions of participation in the Activities expressed by, or posted at, Bounce, Play-n-Create LLC, and will comply and instruct all minor Participants to comply with such rules and conditions; (c) if the undersigned observes any hazard, defect, or dangerous condition significant hazard during participation in the Activities, the undersigned will promptly inform a member of the Bounce, Play-n-Create, LLC, management team; (d) if any minor Participant is attending a party, camp, class, activity, or other program at Bounce, Play-n-Create, LLC, at which food or drink may be available or offered the undersigned has listed below any and all food allergies of each such minor Participant; and (e) all Participants are physically fit and physically able to participate in the Activities, and no Participant has been advised by a health care professional to avoid participation in any of the Activities or any similar activity.

The undersigned is aware that there are inherent risks associated with participation in the Activities, including, but not limited to, the risks of serious bodily injury, death, and property damage, loss, or theft. The undersigned knowingly and voluntarily, on behalf of all Releasors: (a) expressly assumes all risks, known and unknown, foreseen or unforeseen, associated with participation in the Activities or presence at the Facility, and (b) waives all claims arising from participation in the Activities or presence at the Facility, including death or injury to any Participant or damage to, or loss of, property of any person. This release and waiver covers ALL RISKS of death, injury, and property loss or damage, specifically including, but not limited to, those that may arise out of the negligence of any Participant, Bounce, Play-n-Create, LLC, or any other person.

The undersigned, on behalf of all Releasors, forever agrees to RELEASE, INDEMNIFY, PROTECT, HOLD HARMLESS, AND DEFEND Bounce, Play-n-Create, LLC, and its subsidiaries, affiliates, officers, members, employees, agents, licensees, legal representatives, successors, attorneys, and assigns (collectively, the Released Parties), from any and all claims, demands, damages, losses, causes of action, lawsuits of any kind or nature whatsoever, liability, costs, and reasonable attorneys fees (collectively, the Claims and Expenses), past or future, foreseen or unforeseen, arising out of or relating to participation in the Activities or presence at the Facility by any Participant, whether or not involving a third party claim. The undersigned acknowledges that this release and indemnification extends to potential liability for injuries, death, and property loss, theft, or damage caused, or contributed to, by the negligence of any Released Party.

The undersigned, on behalf of all Releasors, further hereby grants to Bounce, Play-n-Create LLC the irrevocable right and permission to: (a) use and reuse, in any manner at all, any photographs, video, voice, and likeness of any of any Participant, in whole or in part, modified or altered, either by themselves or in conjunction with other photographs, video, voices, and likenesses, in any medium or form of distribution, and for any purposes whatsoever, including, without limitation, all Bounce, Play-n-Create LLC promotional and advertising uses, and other trade purposes; and (b) the right to copyright any such photographs, videos, voices, or likenesses in the name of Bounce, Play-n-Create LLC. The undersigned, on behalf of all Releasors, hereby waives, and forever agrees to RELEASE, INDEMNIFY, PROTECT, HOLD HARMLESS, AND DEFEND the Released Parties from, any and all Claims and Expenses, past or future, foreseen or unforeseen, arising out of or relating to the use of any said photograph, video, voice, or likeness, including, without limitation, any and all

claims for invasion of privacy and libel, whether or not involving any third party claim, and the undersigned, further, on behalf of all Releasors, waives any right to inspect or approve the use thereof.

THIS AGREEMENT IS GOVERNED BY THE LAWS OF THE COMMONWEALTH OF VIRGINIA. THE UNDERSIGNED, ON BEHALF OF ALL RELEASORS, HEREBY IRREVOCABLY SUBMITS TO THE JURISDICTION OF THE COURTS OF ALBEMARLE COUNTY, VIRGINIA AND CHARLOTTESVILLE, VIRGINIAIN ANY ACTION OR PROCEEDING ARSING OUT OF, OR RELATING TO, THE ACTIVITIES OR THE SUBJECT MATTER OF THIS AGREEMENT, AND IRREVOCABLY AGREES THAT ALL CLAIMS IN RESPECT TO ANY SUCH ACTION OR PROCEEDING MAY BE HEARD AND DETERMINED ONLY IN SUCH COURTS, TO THE EXCLUSION OF THE COURTS OF ANY OTHER JURISDICTION. THE UNDERSIGNED, ON BEHALF OF ALL RELEASORS, HEREBY WAIVES ANY VENUE, PERSONAL JURISDICTION, OR OTHER OBJECTION THAT ANY RELEASOR MAY HAVE.

The undersigned intends this agreement to constitute a valid waiver and indemnification under Virginia law and for the waiver or rights and assumption of risks to be as broad as permitted under Virginia law. The undersigned acknowledges that this agreement will be used and relied upon by the Released Parties, and that it will govern the Releasors actions and rights and is specific inducement to obtain permission to engage in the Activities. In the event that any portion of this agreement is found to be unenforceable, the remaining portions shall remain in full force and effect.

THE UNDERSIGNED HAS FULLY INFORMED HIMSELF OR HERSELF OF THE CONTENTS OF THIS AGREEMENT BY READING IT IN FULL BEFORE SIGNING.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Allergy Info
Does this child have any allergies?*
No
Yes

If yes please describe?
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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