Loading...

LIABILITY WAIVER

I hereby agree that in engaging in any activities at Mon Amie Harlow (the “Company”), and utilizing its facilities located at 114 Royce Street, Suite A, Los Gatos, CA 95030 (the “Location”), I will hold Mon Amie Harlow, and/or their agents, owners, officers, directors, representatives, assigns, affiliates, volunteers, participants, employees, insurers, and all other persons or entities acting in any capacity on their behalf, harmless. In furtherance of the same, I agree to the following terms and conditions:

PARENT MUST REMAIN AT THE LOCATION. I assume all responsibility for supervising and monitoring my child/children while at the Company. The Company is not a child care provider, nor are their employees . Parents are to remain onsite with their child during the duration of their stay. Parent/s and child must comply with all written and oral instructions/rules of the Company employees and representatives with regards to safety and rules of the Facility. Parent is entirely responsible for monitoring each child's activities, for the safety of each child and for ensuring that each child remains at the Company until Parent leaves the Facility.

AUTHORITY. I hereby represent that I am authorized and/or empowered to execute this Agreement on behalf of my child and/or children. I hereby acknowledge that the Company is relying on said representation in permitting the entrance of the Participants into its facilities.

PHYSICAL HEALTH. I certify that I, my child and/or my children (hereinafter collectively the referred to a the "Participants") are physically able to participate in all activities at the Location without aid or assistance. I, on behalf of the Participants, further certify that the Participants are willing to assume the risk of any medical or physical condition that they may have. I, on behalf of the Participants, acknowledge that I have read the rules governing participation in any activities at the Location. I certify that I have explained the Company rules to my child and/or children. I understand that the Company rules have been implemented for the safety of all guests at the Location. I acknowledge that failure to follow the rules can result in the expulsion of the Participants from the Location.

ACKNOWLEDGMENT OF RISKS. I acknowledge that the Participants will be interacting and/or playing with other participants, parents and employees of the Company. By entering the Facility, Participants may be exposed to communicable diseases, or items to which the child may be allergic, rough play, accidents and other circumstances. Any of the foregoing may cause property damage, bodily injury, or death. Parent has full knowledge and awareness of the foregoing risks and willingly assumes, on behalf of him/herself, each child, the child's legal guardians and custodians and their respective successors, heirs and assigns (collectively, the "Parent Parties"), all risks associated with the use of the Facility. If Parent has any concerns about a child's allergies or medical condition or about the fact that child may be exposed to allergens or other risks, Parents should not allow child to use the Facility. The Participant's participation at the Company is purely voluntary and made in spite of the aforementioned risks. If any Participant becomes injured, I acknowledge that said Participant may require medical assistance, which shall be provided at my own expense or the expense of my insurance provider. I hereby represent and affirm that I have adequate and appropriate insurance to provide coverage for such medical expense. I UNDERSTAND AND AGREE THAT THE COMPANY WILL NOT PAY FOR ANY COST OR EXPENSES INCURRED IF ANY PARTICIPANT IS INJURED UNLESS SUCH INJURY WAS CAUSED BY THE GROSS NEGLIGENCE OF THE COMPANY.

LEGAL WAIVER AND INDEMNITY. I, on behalf of the Participants, do agree to hold harmless, release and discharge the Company of and from all claims, demands, causes of action, and legal liability, whether the same be known or unknown, anticipated or unanticipated: I shall not bring any claims, demands, legal actions and causes of action, against the Company for any economic and non-economic losses due to bodily injury, death, property damage sustained by the Participants that are in any way associated the activities at the Location, including but not limited to loft fort or other activities. Should the Company or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this Agreement, I, on behalf of the Participants, agree to indemnify and hold them harmless for all such fees and costs. I further acknowledge that in the event that any third-party brings a claim or lawsuit against any or all of the Participants, I may be found by a court of law to have waived my right to maintain a lawsuit against the Company on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I understand this Agreement and I voluntarily agree to be bound by its terms.

REMOVAL FROM LOCATION. I, on behalf of the Participants, acknowledge that the Company has the right to remove Participants for violation of the Company Rules, indecent and/or obscene behavior including use of foul language towards any employees or guest of the Company.

BINDING EFFECT. This agreement shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns.

GENDER AND PLURAL. Unless inconsistent with the context, words signifying any one gender shall include the other's, words signifying the singular shall include the plural and vice versa and words signifying natural persons shall include artificial persons and vice versa.

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*
Check to receive information, news, and discounts by e-mail.
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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver