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Community Play Workshop, Inc

DBA

"The Children's Piazza"

83 Pine Street, Unit F, Peabody, MA 01960


WAIVER OF LIABILITY AGREEMENT


In consideration of being allowed to enter the play area and/or participate in any party, drop-in play and/or enrichment program at Community Play Workshop, Inc, a 501(c)3 non-profit organization, DBA "The Children's Piazza" and/or use of the property, facilities and services therein, I agree to the following: 

  1. I agree that the participant(s) named below and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for admission and participation. 

  2. I understand and agree that it is my responsibility to supervise and monitor the safety of the minors in my care while on the premises.

  3. I understand that socks are required to enter the play area.

  4. I understand that FOOD is NOT allowed in the play areas.

  5. I agree that any violation of this agreement and/or the rules below could result in expulsion from our facility, with no monetary or other reimbursement. 

  6. I understand that there are dangers and risks associated with activities/play equipment at The Children’s Piazza, and I knowingly and freely agree to assume all risk of personal injury, including the potential for paralysis and death for myself and for each participant listed below. 

  7. On behalf of myself and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, I HEREBY RELEASE INDEMNIFY AND HOLD HARMLESS COMMUNITY PLAY WORKSHOP, INC, its affiliates, officers, members, agents, employees, other participants and sponsoring agencies from and against any and all claims, injuries, theft, property damage, liabilities or any kind of action arising out of or related to participation in any and all programs, activities, parties, and the use of the play equipment. 

I further understand that the terms of this agreement are legally binding and certify that I am signing this agreement after reading it. I HAVE READ THIS DOCUMENT & UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

DATE: April 28, 2025


First Guest Name

First Name*

Last Name*
First Guest Age Acknowledgment*
First Guest Date of Birth*
I certify that I am 14 years of age or older
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Tenth Guest Name

First Name*

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

Email*

Confirm Email*
CHECK this BOX if you'd like to receive occasional e-mails about special discounts and events. We do not share any personal information, and send an average of 1-2 emails per month.
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 14 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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