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ASSUMPTION OF THE RISK, RELEASE AND WAIVER OF LIABILITY, 
INDEMNITY AGREEMENT AND MEDICAL CONSENT (“WAIVER”)

 

In consideration of being allowed to enter and/or participate in any activities at Millie Moos inc'. (‘Activities”), the undersigned acknowledges, appreciates and agrees to the following: 

 

1. Playground equipment can be dangerous and can result in serious injury to me/my child/children. I understand the nature of Activities and represent that I am qualified, in good health, and in proper physical condition to participate in such Activities. If I believe any of the Activities are unsafe, I will immediately stop participating. I understand that these Activities may involve risk of serious bodily injury, and all such risks, including presently unknown or unforeseeable risks, and voluntarily assume all responsibility for losses resulting from participation in these Activities. 

 

2. I also assume ALL responsibility for supervising and monitoring my child/children while at Millie Moos inc'. Millie Moo's staff are not responsible for taking care of my child/children.

 

3. I hereby forever release and discharge Millie Moos inc', its respective owner, heirs, shareholders, administrators, directors, agents, officers, lessors, volunteers, employees, other participants, any sponsors, and advertisers (‘Releases”) from any and all liability, claims, demands, losses, or damages, however caused, whether related to property damage, theft, and/or personal injury, and whether based on tort, intentional act, strict liability, negligence, and/or cost which relates to, or arises from, this waiver, to the fullest extent permitted by law. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance notwithstanding, shall continue in full force and effect. 

 

4. I also understand and agree that my execution of this waiver on the initial visit, or for one of my children, will authorize Millie Moos inc', to enter this waiver into its database and use it as a continuous, multi-use waiver for my child’s/children’s ongoing participation in the activities or use it as a waiver 

executed for my other child/children. I hereby authorize Millie Moos inc', to use this waiver as a multi- use waiver until such time as I revoke it in writing. 

 

PARENTAL/LEGAL GUARDIAN CONSENT 

AND I, agree I am the responsible person, parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe that Minor to be qualified to participate in such activities. I hereby Release, discharge, covenant not to sue and agree to indemnify and save and hold harmless each of the Releases from all liability, claims, demands, losses or damages on the Minor’s account caused or alleged t have been caused in whole or in part by the negligence of the Releases or otherwise including negligent rescue operations, and further agree that if, despite this release, I the Minor, or anyone in the Minors behalf makes a claim against any of the above Releases, I will Indemnify, save and hold harmless each of the Releases from any litigation expenses, attorney’s fees, loss liability, damages, or cost any Releasees may incur as a result of any such claim. 

 

MEDICAL PERMISSION AUTHORIZATION 

If the participant is of minority age, the undersigned parent or guardian hereby gives permission for Millie Moos inc', to authorize emergency medical treatment as may be deemed necessary for the Minor named below while participating in Millie Moos inc'. The undersigned hereby releases discharge, covenant not to sue and agrees to indemnify and save and hold harmless Millie Moos inc', from all liabilities, claims, demands, losses or damages on the minor account caused or alleged to have been caused in whole or in part by the negligent medical treatment, failure to provide medical treatment, or negligent rescue operations, and further agrees to indemnify, save and hold harmless Millie Moos inc', from any litigation expenses, attorney’s fees, loss liability, damages, or cost incurred by Millie Moos inc' as a result of any such claim. 


PERMISSION TO USE PHOTOGRAPHY

I grant to Millie Moos inc', the right to take photographs of me and my family. I authorize Millie Moos inc', it’s assigns and transferee’s to copyright, use and publish the same in print and or electronically. I agree that such photographs may be used with or without my name with any lawful purpose including but not limited to publicity, illustration advertisement and Web content. 

 

I HAVE READ THE ABOVE MEDICAL PERMISSION AUTHORIZATION AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE MILLIE MOOS INC', FROM ALL LIABILITY ARISING AS THE RESULT OF THE MEDICAL PERMISSION AUTHORIZATION.


First Parent's Name

First Name*

Last Name*

Phone*
First Parent's Date of Birth*
First Parent's Signature*
Second Parent's Name

First Name*

Last Name*
Second Parent's Date of Birth*
Third Parent's Name

First Name*

Last Name*
Third Parent's Date of Birth*
Fourth Parent's Name

First Name*

Last Name*
Fourth Parent's Date of Birth*
Fifth Parent's Name

First Name*

Last Name*
Fifth Parent's Date of Birth*
Sixth Parent's Name

First Name*

Last Name*
Sixth Parent's Date of Birth*
Seventh Parent's Name

First Name*

Last Name*
Seventh Parent's Date of Birth*
Eighth Parent's Name

First Name*

Last Name*
Eighth Parent's Date of Birth*
Ninth Parent's Name

First Name*

Last Name*
Ninth Parent's Date of Birth*
Tenth Parent's Name

First Name*

Last Name*
Tenth Parent'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.


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*

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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