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Jumpin' Jellybeans Boutique Play Space Waiver and Release Form

As parent or legal guardian of the child whose name is set forth below (who is referred to herein as the “Participant”) and in consideration of the Participant being permitted to participate in the Activities (as defined below) conducted by Jumpin' Jellybeans LLC (“ The Boutique Play Space”), the Participant and I agree as follows: 

1.  Activities - The Participant will participate in various activities offered by Jumpin' Jellybean LLC (the "Activities"), including but not limited to, the following:

2.  Assumption of Risk - I understand that the Activities entail the risk of severe bodily injury to the Participant. Injuries that could result will vary, but may include (a) minor injuries such as scratches, bruises and sprains; (b) major injuries such as eye injury or loss of sight, joint or back injuries and concussions; and (c) catastrophic injuries, including paralysis and even death. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, for myself and the Participant and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any injury arising out of or related to the Activities.

3.  Release, Discharge and Agreement Not To Sue - I, for myself and the Participant and our respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue Jumpin' Jellybeans inc (boutique playspace) and its managers, members, employees and/or other agents, for any injury to or death of the Participant  arising, directly or indirectly, from participation in the Activities. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of Jumpin' Jellybeans LLC (the boutique playspace) and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract or otherwise.

4.  Indemnification And Hold Harmless – I agree to indemnify Jumpin' Jellybeans LLC (the boutique playspace) and hold jumpin' Jellybeans LLC (the boutique playspace) harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees and costs, incurred due to claims brought by any third party as a result of or arising out of the Participant's involvement in the Activities and to reimburse Jumpin' Jellybeans LLC (the boutique playspace) for any such costs, expenses and fees as they are incurred. 

5.  Parent Or Legal Guardian Certification And Consent -I hereby certify that I am the parent or legal guardian of the Participant whose name appears below, and I have authority to waive rights on behalf of the minor Participant. I have read and I understand all of the provisions of this document and the risks of the Activities. I understand that the Activities could cause injury and even death. I acknowledge that I have read and understand the terms of this document and I am freely and voluntarily signing this document.

6.  Severability - This document is intended to be as broad and inclusive as is permitted by the laws of the State of Tennessee and if any provision (or a part of any provision) contained herein is deemed to be invalid, the balance of the provisions shall continue in full legal force and effect, notwithstanding such invalidity.

First BEANS Name

First Name*

Last Name*

Phone*
First BEANS Date of Birth*
I certify that I am 18 years of age or older
First BEANS Signature*
Second BEANS Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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*

Phone*
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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