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FlippityFlop, LLC

2 Kings Way Ave, Units D&E | Exeter, NH 03833

603.418.7997  |  www.flippityflopgym.com  | info@flippityflopgym.com

As consideration for being allowed to enter the play area/or participate in any party and/or program, use of any equipment, amenities and facilities, held on property owned by, leased by, borrowed or used by FlippityFlop, LLC, I acknowledge that there may be some inherent risks, both known and unknown, including negligence of other participants and potentially severe injuries including but not limited to serious bodily injury, permanent disability, paralysis and death.   I hereby give consent for myself and the child(ren) identified below to participate in any and all offerings by flippityflop, LLC and I fully accept and assume all such risks and all responsibility to losses, costs, and damages I and/or the child(ren) incur from such participation.

Safety Rules: I hereby acknowledge and agree: that any inappropriate behavior, such as, but not limited to, harassment, endangerment of self or another person, or foul language will result in the immediate removal from the premises; that it is my responsibility to remain on the premises and to supervise the child(ren) - to observe, obey and enforce gym safety rules at all times; that socks are mandatory; that all food and drinks in the designated areas only; that flippityflop is not responsible for lost or stolen items; that the child(ren) are aware of these rules; and that I and the child(ren) have no illness or injury that may affect the safe enjoyment of flippityflop by us or other guests.

I hereby forever release, discharge, covenant not to sue, indemnify and hold harmless flippityflop, LLC, its officers, directors, shareholders, employees, contractors, teachers, coaches and volunteers from and against any and all injuries, illnesses, medical conditions, damages, claims, liabilities, expenses or judgments, property damage/loss, including attorney’s fees and court costs whether caused by negligence or otherwise.  By this waiver, I, on behalf of myself, the child(ren) and my/their heirs assigns, personal representatives and next of kin, assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with FlippityFlop, LLC.

Consent to Medical Treatment: I hereby authorize and release flippityflop staff to render first aid to myself and the child(ren), transport or arrange transport to a medical or dental facility, and/or call for medical help should flippityflop staff deem this to be necessary in which I hereby agree to be personally responsible for payment.  

Photo Release: I understand that flippityflop occasionally takes photos for advertising, promotional, media or any other legitimate purpose and that These photos will not have names or personal identifiers without consent and I hereby give permission to such use.

Parent/Guardian/Caregiver Certification and Consent: I hereby certify that I am of 18 years of age or older and/or that I am the parent/guardian/caregiver of the minor Participant(s) whose name(s) appears below, and I have authority to waive rights on behalf of the minor Participant(s). I understand that this is a permanent waiver to be kept on file by FlippityFlop, LLC for today’s visit and all subsequent and future visits. I have informed myself on the contents of this waiver from FlippityFlop, LLC and hereby voluntarily release from liability and indemnify FlippityFlop, LLC by signing this agreement.

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or 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*
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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