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Funtasia Palace, INC.

&

Kings Bay YM-YWHA Inc.

Waiver, Release, Hold Harmless, and Indemnification Agreement

and 

Waiver of Liability Relating to Coronavirus/COVID-19


As Consideration for being allowed to enter and participate in the bounce play area in the auditorium or gymnasium/ pool to swim or observe/ party rooms and/or participate in any party and/or program at Funtasia Palace, INC d/b/a FUNTASIA and Kings Bay YM-YWHA Inc. the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified, acknowledges, appreciates, understands, and agrees to the following:

1.   I represent that I am the parent, responsible party or legal guardian of the Participant(s) named or I have obtained permission from the parent/legal guardian of the Participant(s) named to execute this agreement on their behalf.

2.   I acknowledge and understand that there are risk associated with participation in Funtasia Palace, INC d/b/a FUNTASIA and Kings Bay YM-YWHA Inc. activities and the use of the play area, pool and inflatable equipment, basketball hoops, any sports games and LASER TAG GAME including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death.

3.   I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume.

4.   I agree that the Participant(s) named, and I shall comply with all verbal instructions as conditions for participation in any party/event and/or program at Funtasia Palace, INC d/b/a FUNTASIA and Kings Bay YM-YWHA Inc.

5.   I, for myself, the Participant(s) named, our heirs, assigns, representatives, and next of kin agree to hold harmless and indemnify the independent owner of Funtasia Palace, INC d/b/a FUNTASIA and Kings Bay YM-YWHA Inc.., their predecessors, parent, subsidiaries and affiliates, officers, and employees from any and all injuries, liabilities or damages from participation.

6.   I additionally agree to indemnify the independent owner of Funtasia Palace, INC d/b/a FUNTASIA and Kings Bay YM-YWHA Inc., their predecessors, parent, subsidiaries, and affiliates, officers, and employees for any defense cost or expense arising from any and all claims, injuries, liabilities, or damages arising from participation.

7.   I am of physical ability to participate and am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion.

                       

 ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19

    

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death. Funtasia Palace INC and Kings Bay YM-YWHA Inc. cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing Funtasia Palace INC and Kings Bay YM-YWHA Inc. services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Funtasia Palace INC and Kings Bay YM-YWHA Inc.services and/or enter onto Funtasia Palace INC and Kings Bay YM-YWHA Inc. premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Funtasia Palace INC and Kings Bay YM-YWHA Inc. services and enter Funtasia Palace INC located inside Kings Bay YM-YWHA Inc. premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Funtasia Palace INC and Kings Bay YM-YWHA Inc. services and premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against [name of company] and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Funtasia Palace INC and Kings Bay YM-YWHA Inc.services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. CHOICE OF LAW: I understand and agree that the law of the State of New York will apply to this contract.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

 

Date: August 16, 2022


First Adult Name

First Name*

Last Name*

Phone*
First Adult Date of Birth*
First Adult Signature*
Second Adult Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Adult Date of Birth*
Event Date

Date of the event: *
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*

Last Name*

Relationship*

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.


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