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Child Care Authorization Form 

PARTICIPANT AGREEMENT RELEASE AND ASSUMPTION OF RISK

 

In consideration of the services at provided at Jungle Island by any of ESJ JI Operations, LLC; and of their respective agents, owners, officers, volunteers, participants, employees, affiliates, and all other persons or entities acting in any capacity on their behalf (collectively, the “Jungle Island Group”), I hereby agree to release, indemnify, and discharge on behalf of myself, my spouse, my children (if Participant is under the age of 18), my heirs, assigns, personal representative and estate as follows:

 

I and the Participant (if applicable) acknowledge that the Adventure Attractions including Zip Line, Ropes Course, Rock Wall, Spider Mountain, and Auto-Bungee (collectively the “Attractions”) as well as the Animal Encounters and all animal interactions entail known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I and the Participant (if applicable) understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activity.

I and the Participant (if applicable) expressly agree to accept and assume all of the risks existing in this activity. My and the Participant’s (if applicable) participation in this activity is purely voluntary, and I and the Participant (if applicable) elect to participate in spite of the risks.

I and the Participant (if applicable) hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless the Jungle Island Group from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of equipment or facilities, including any such claims which allege negligent acts or omissions of the Jungle Island Group.

Should any persons comprising the Jungle Island Group or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I and the Participant (if applicable) agree to indemnify and hold them harmless for all such fees and costs.

I certify that I and the Participant (if applicable) have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I and the Participant (if applicable) am willing to assume the risk of any medical or physical condition I may have.

I and the Participant (if applicable) acknowledge and agree that the Jungle Island Group has made no representation or warranty as to the suitability of the Attractions, Animal Encounters or any animal interactions for any specific purpose.

The Jungle Island Group shall not undertake responsibility nor shall it be liable for the actions of any participant or third party in the Attractions by the Jungle Island Group and its past, present and future parents, subsidiaries (whether or not wholly-owned), affiliates, divisions, agents, representatives, officers, directors, employees, staff, agents, servants, successors and assigns, the owner of the venue of the Attractions, sponsors, or independent contractors shall not be responsible for any loss, costs, damages, consequential, special or punitive, or liability incurred by Participant of any nature including, but not limited to, those arising from any form of negligence, gross negligence, strict liability, reckless misconduct, intentional torts, personal injury, or criminal activity.

I and the Participant (if applicable) acknowledge and agree that this Agreement and Waiver is made in the State of Florida and shall be governed by and construed in accordance with Florida law without respect to its choice of law provisions; any lawsuit brought against the Jungle Island Group may only be brought in the State of Florida and that the prevailing party in any litigation, arbitration or mediation relating to this Agreement shall be entitled to recover its reasonable attorneys’ fees from the other party for all matters including, but not limited to, appeals.

I and the Participant (if applicable) acknowledge and agree that all of the acknowledges, agreements, understandings, covenants, promises, representations, warranties, waivers, consents and releases contained in this Agreement and Waiver shall be binding upon me, my heirs, executors, administrators, personal or legal representatives, successors, assigns and all members of my family.

I and the Participant (if applicable) agree that if any portion of this Agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

In consideration of any minor being permitted by his or her parents or guardian to participate in this activity, I further agree to indemnify and hold harmless the Jungle Island Group from any and all claims which are brought by, or on behalf of minor, and which are in any way connected with such use or participation by minor.

By signing this document, I and the Participant (if applicable) acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I and the Participant (if applicable) may be found by a court of law to have waived my right to maintain a lawsuit against the Jungle Island Group on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I and the Participant (if applicable) agree to be bound by its terms.

This waiver may be executed by facsimile, scanned or electronic signature, which in each case shall constitute an original for all purposes. I further consent to the recording of my likeness and/or other biometric data as evidence of my identity.


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

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

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Child Care Authorization Form

For participation in Animal Encounters, any animal interaction, or any attraction at Jungle Island, liability waivers must be signed by a parent or appointed guardian prior to participation. Any appointed guardian must provide notarized documentation of guardianship. You can use this form and it must be filled out entirely.


I, 


Name if Parent or Legal Appointed Guardian *

the undersigned parent of


Minor's Full Name *

hereby grant


Name of Temporary Guardian *

temporary guardianship for the child named above.  

This grant of temporary guardianship shall begin on


Click to customize date box label

and remain in effect until 


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The above named guardian shall have the power to: Select all that apply
Seek appropriate medical treatment or attention on behalf of the child as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits.
Authorize medical treatment or medical procedures in an emergency situation.
Sign and releases to authorize participation in any Jungle Island attraction, Animal Encounter or any animal interaction.
Assume guardianship for all of the above purposes and associated that pertain thereto without limitation.

Please note that (print child name) has a specific medical condition or allergy: Described as


Medical Conditions or Allergies
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*

Middle 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.


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