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HIPPITY HIP COMMUNITY PLAYSPACE, INC

ASSUMPTION OF RISK, INDEMNITY AGREEMENT AND RELEASE

In consideration of the permission granted to enter onto the premises of Hippity Hip Community Playspace, INC (the “Playspace”) and to use the amenities located thereon, I hereby agree on behalf of myself and the undersigned minor for whom I am signing as parent or legal guardian (the “Minor”), and each of our respective heirs, assigns, executor(s) or administrator(s), personal representatives and estates, to the following, which includes, without limitation, an agreement to release, indemnify and discharge Hippity Hip Community Playspace, INC, the Playspace, and each of their respectiveowners, managers, employees, agents, contractors, subcontractors, representatives, predecessors, successors and assigns, and all other persons and/or entities acting in any capacity on their behalf (hereinafter collectively referred to as “Owner”):

 

1. I, on behalf of myself and the Minor, hereby assume all risk and responsibility for any injuries incurred by me and/or the Minor due to or during my presence on the Playspace premises and/or arising from or in connection with use of Playspace amenities and participation in any and all activities and programs offered by the Playspace and/or taking place at or on the Playspace premises (collectively, “Playspace Activities”).  This assumption of risk and all other agreements and obligations herein, including those included in the below indemnification provisions, shall apply regardless of whether the Playspace Activities are conducted or overseen by Owner, employees, agents, independent contractors or others.

 

2. I, on behalf of myself and the Minor, hereby assume all risk and responsibility for any and all illnesses, injuries or harm to me or the Minor arising from or in connection with participation in Playspace Activities.  I hereby affirm that the Minor is in good physical condition and does not suffer any illness or disability that would prevent or limit participation in any Playspace Activity.  I understand that the Owner does not have any expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific activity on any medical condition(s), or in providing professional nutritional advice.

 

3. I, on behalf of myself and the Minor, hereby release, forever discharge, and agree to indemnify, defend and hold harmless the Playspace and the Owner (collectively, the “Indemnitees”), from any and all costs, liabilities, damages, obligations, claims, demands, or causes of action that are in any way connected with my participation in Playspace Activities,my use of the Playspace equipment or amenities, and/or my entry onto the Playspacepremises, including any claims, demands or causes of action based on or arising out of alleged acts, omissions and/or negligence of the Indemnitees.  The agreement on my part to indemnify, defend and hold the Indemnitees harmless stated earlier in this paragraph shall apply in full to any and all costs, liabilities, damages, obligations, claims, demands, or causes of action that are in any way connected with the Minor’s participation in PlayspaceActivities, use of the Playspace equipment or amenities, and/or entry onto the Playspacepremises.  Should the Indemnitees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 

 

4. The laws of the State of New York shall govern this document.  I understand and agree that if any provision of this document is found to be unenforceable by a court of law, that finding shall not alter or void the remainder of the document and the rights and responsibilities expressed therein.  This document shall be binding upon myself and the Minor with respect to entry onto the Playspace premises and/or participation in any Playspace Activities on the date set forth below and at any and all times after that date. 

 

My execution of this document shall be deemed to be binding upon the Minor to the fullest extent permitted by law.  By signing this document, I acknowledge that if anyone suffers injury or death relating in any manner to entry onto the Playspace premises and/or participation in any Playspace Activities by myself or the Minor, I may be found by a court of law to have waived my right or the Minor’s right to maintain a lawsuit against the Playspace and/or Owner on the basis of any claim from which I have released them herein, and to be liable for damages to the Playspace and/or Owner and/or any such person. 

 

I have had sufficient opportunity to read this entire document. I have read and understand it, and I agree to be bound by its terms.

 

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
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.
Photo Release

I, on behalf of myself and the Minor, hereby grant the Owner the irrevocable right to use my and the Minor's picture, portrait or photograph, in all forms, media and manners, without restriction as to changes or alterations, for advertising, trade, promotion, exhibition, or any other lawful purposes. 

 

I, on behalf of myself and the Minor, hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right or compensation from the use of the photographs or my name identifying me as a participant or subject of the photos.

No
Yes
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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