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The Children’s Piazza, LLC
WAIVER OF LIABILITY AND AGREEMENT

In consideration of being allowed to enter the play area and/or participate in any party, free play and/or program at The Children’s Piazza, LLC of Beverly, MA and/or use of the property, facilities and services of Children’s Piazza, I agree to, acknowledge and represent for myself and for the members of my family 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 participation in any party, free play and/or program at Children’s Piazza.  
     
  2. I UNDERSTAND AND AGREE THAT IT IS MY RESPONISIBLITY TO SUPERVISE MY CHILD/PARTICIPANTS LISTED BELOW AT ALL TIMES. 
     
  3. I understand that socks are required (no outdoor shoes or bare feet on the foam mats).
     
  4. I understand that food/snacks are not to be eaten in the play areas.
     
  5. I agree that violation of this agreement and/or the rules below could result in expulsion from Children’s Piazza, 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 CHILDREN’S PIAZZA, 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 Children’s Piazza 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: December 12, 2018

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*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to be added to our e-mail list for upcoming events and specials. Otherwise, we will NOT use your information for any purpose other than our records! No personal information is shared.
Additional Information

CITY: *

STATE: *

PHONE: *
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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