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KIDSEPOLIS DAYCARE AND FAMILY ENTERTAINMENT CENTRE INC. (KIDSOPOLIS).

A COMPLETED AND SIGNED WAIVER BY A PARENT/GUARDIAN IS REQUIRED FOR ALL MINORS ENTERING KIDSOPOLIS FAMILY ENTERTAINMENT CENTRE. SORRY, NO EXCEPTIONS.

ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, INDEMNITY AGREEMENT AND MEDICAL CONSENT (WAIVER)

In consideration of being allowed to enter and/or participate in any activities at Kidsopolis (activities), the undersigned

acknowledges, appreciates and agrees to the following:

 

1. Playground equipment can be dangerous and can result in serious injury to me/my child/children. I understand the nature of

activities and represent that I am qualified, in good health, and in proper physical condition to participate in such Activities. If I believe any of the activities are unsafe, I will immediately stop participating. I understand that these activities may involve risk of serious bodily injury, which may be caused by my own actions/inaction or actions/inaction of other participants. I hereby knowingly and voluntarily assume any and all such risks, including presently unknown or unforeseeable risks, and voluntarily assume all responsibility for losses resulting from participation in these activities.

 

2. I also assume all responsibility for supervising and monitoring my child/children while at Kidsopolis.

 

3. I hereby forever release and discharge Kidsopolis, its respective owners, heirs, shareholders, administrators, directors,

agents, officers, lessors, volunteers, employees, other participants, any sponsors, and advertisers (Releasees) from any and all liability, claims, demands, losses, or damages, however caused, whether related to property damage, theft, and/or personal injury, and whether based on tort, intentional act, strict liability, negligence, and/or negligent rescue. I will indemnify, save and hold harmless each of the Releasees from any claim, expense, attorneys fees, loss, liability, damage, or cost which relates to, or arises from, this Waiver, to the fullest extent permitted by law. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

 

4. I also understand and agree that my execution of this Waiver on the initial visit, or for one of my children, will authorize Kidsopolis to enter this Waiver into its database and use it as a continuous, multi-use waiver for my childs/childrens ongoing participation in

the Activities or use it as a Waiver executed for my other child/children. I hereby expressly authorize Kidsopolis to use this Waiver as a multi-use waiver until such time as I revoke it in writing.

 

PARENTAL/LEGAL GUARDIAN CONSENT

AND I, the Minors parent and/or legal guardian, understand the nature of the above referenced Activities and the Minors experience and capabilities and believe that Minor to be qualified to participate in such Activities. I hereby Release, discharge, covenant not to sue and agree to indemnify and save and hold harmless each of the Releases from all liability, claims, demands, losses or damages on the Minors account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the Minor, or anyone on the Minors behalf makes a claim against any of the above Releasees, I will indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorneys fees, loss liability, damages, or costs any Releasee may incur as a result of any such claim.

 

MEDICAL PERMISSION AUTHORIZATION

If the participant is of minority age, the undersigned parent or guardian hereby gives permission for Kidsopolis to authorize emergency medical treatment as may be deemed necessary for the Minor/s named below while participating in Kidsopolis Activities. The undersigned hereby releases, discharges, covenant not to sue and agrees to indemnify and save and hold harmless Kidsopolis from all liability, claims, demands, losses or damages on the Minors account caused or alleged to have been caused in whole or in part by the negligent medical treatment, failure to provide medical treatment, or negligent rescue operations, and further agrees to indemnify, save and hold harmless Kidsopolis from any litigation expenses, attorneys fees, loss liability, damages, or costs incurred by Kidsopolis as a result of any such claim.

 

I HAVE READ THE ABOVE MEDICAL PERMISSION AUTHORIZATION AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE KIDSOPOLIS FROM ALL LIABILITY ARRISING AS THE RESULT OF THIS MEDICAL PERMISSION AUTHORIZATION.

First Parent/Legal Guardian Name

First Name*

Last Name*
First Parent/Legal Guardian Date of Birth*
I certify that I am 18 years of age or older
First Parent/Legal Guardian Signature*
Second Parent/Legal Guardian Name

First Name*

Last Name*
Second Parent/Legal Guardian Date of Birth*
Third Parent/Legal Guardian Name

First Name*

Last Name*
Third Parent/Legal Guardian Date of Birth*
Fourth Parent/Legal Guardian Name

First Name*

Last Name*
Fourth Parent/Legal Guardian Date of Birth*
Fifth Parent/Legal Guardian Name

First Name*

Last Name*
Fifth Parent/Legal Guardian Date of Birth*
Sixth Parent/Legal Guardian Name

First Name*

Last Name*
Sixth Parent/Legal Guardian Date of Birth*
Seventh Parent/Legal Guardian Name

First Name*

Last Name*
Seventh Parent/Legal Guardian Date of Birth*
Eighth Parent/Legal Guardian Name

First Name*

Last Name*
Eighth Parent/Legal Guardian Date of Birth*
Ninth Parent/Legal Guardian Name

First Name*

Last Name*
Ninth Parent/Legal Guardian Date of Birth*
Tenth Parent/Legal Guardian Name

First Name*

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

Email*

Confirm Email*
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First and Last Name(s) of Participant(s)/Minor(s)
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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