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I am either the Parent or Guardian of the parties in attendance of the Little Movers event and do undersign to follow and adhere to the rules outlined below. Furthermore, I hereby agree to Little Movers, its owners and employees against any claims made by myself or the participants at the event resulting from any loss of property or injury suffered while using the playground areas or associated areas of the event space. I understand that there are inherent risks associated with use of these playground areas at Little Movers that could result in serious injury or death. If I am not the Parent or Guardian listed below, then I hereby represent that I have obtained authorization from the Parent or Guardian of each such Participant to execute this Waiver and Indemnification on their behalf. Little Movers upholds a high regard for safety and expect the following regulations be followed 100% of the time.

 

Children in play area must be 4 and under

All shoes must be stowed in the shoe bins and socks must be work at all times

No sharp objects or jewelry allowed in the play area; please check all children upon entering

Long hair must be contained at all times

No food, drinks, or chewing gum in the play area

No leaping to and from equipment

Enter and exit equipment through the intended entrances and exits

Parent or Guardian is responsible for the supervision of children at ALL TIMES

Today's Date: December 10, 2019

First Guardians Name

First Name*

Last Name*
First Guardians Date of Birth*
I certify that I am 18 years of age or older
First Guardians Signature*
Second Guardians Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Guardians Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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