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A COMPLETED AND SIGNED WAIVER FORM IS REQUIRED TO PARTICIPATE AT SIMPLY PLAY


In consideration of being allowed to enter the play area and/or participate in any party, free play and/or program at SIMPLY PLAY

of Seekonk, MA, and/or Plainville, MA, the undersigned, on his or her behalf, and on behalf of the participants(s)

identified below, acknowledges, and agrees to the following conditions:


I represent that I am the parent and/or legal guardian and/or caretaker and/or currently have authorization and responsibility for the below-named participant(s) to execute this agreement on their behalf.


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 SIMPLY PLAY. I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO SUPERVISE MY CHILD AT ALL TIMES. I am aware that violation of rules could result in expulsion from SIMPLY PLAY with no monetary reimbursement.


I understand that there are dangers and risks associated with the activities and different types of play and equipment at SIMPLY PLAY, and

knowingly and freely agree to assume all risk of personal injury, including the potential for paralysis and death. On behalf of myself and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless SIMPLY PLAY of Seekonk, MA, and/or Plainville, MA, their 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 SIMPLY PLAY programs, activities, parties, and the use of the play equipment and/or area.


I am fully aware, understand and agree to abide by the terms listed below.


• Parents/guardians/caretakers/adults responsible must supervise their children, or the children under their control, at all times.

• Socks must be worn by children and adults in play area (no bare feet).

• No outside food or beverages allowed on the premises.

• No strollers and/or carriages allowed in play area.

• I agree to respect and uphold all of SIMPLY PLAY’s written and verbal policies and

procedures.


I understand that entry, by myself and the participant(s) named, constitutes consent for SIMPLY PLAY to use any film, video, audio, or any likeness of participants for purposes including, but not limited to, marketing, without payment to the participant.



First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
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*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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 Age Acknowledgment*
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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