Loading...

PARENT WAIVER

As Consideration for being allowed to enter the play area and/or Participate in any party and/or program involving HOP-A-LOT LLC equipment, on his or her behalf, and on the behalf of the Participant(s) identified, acknowledges, appreciates, understands, and agrees to the following:

  1. I represent that I am the parent or legal guardian of the Participant(s) named or I have obtained permission from the parent/legal guardian of the Participant(s) named to execute this agreement on their behalf.
     
  2. I acknowledge and understand that there is risk associated with participation in THE BOUNCE HOUSE activities and the use of the play area and inflatable equipment including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death.
     
  3. I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume.
     
  4. I agree that the Participant(s) named, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party and/or program with HOP-A-LOT LLC equipment.  This includes wearing SOCKS at all times on inflatables.
     
  5. I, for myself, the Participant(s) named, our heirs, assigns, representatives, and next of kin agree to hold harmless and indemnify the independent owner of HOP-A-LOT LLC, their predecessors, parent, subsidiaries and affiliates, officers, and employees from any and all injuries, liabilities or damages from participation.
     
  6. I am of physical ability to participate and am legally competent to understand and complete this agreement.  I hereby execute this agreement without coercion.
     
  7. I, the parent, or guardian acknowledge that I am responsible for all children under the age of 16. I understand that I cannot leave my child unattended and assume all responsibility for them. It is my duty as the parent/guardian to keep track of the child/ren.

I have read the Waiver, Release, Hold Harmless, and Indemnification Agreement.

By signing below, I acknowledge that I agree to the content of the waiver/agreement.

Today's Date: February 21, 2019

First Participant's Name

First Name*

Last Name*

Phone*
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*
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*
Zip Code

Zip Code *
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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver