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Participation Agreement

Definitions:

Participant means any person on whose behalf You are signing this form.

Play Street Museum means any Play Street Museum location, Play Street Museum Lubbock, Diamond Children's Interactive of Lubbock, LLC,  PSM Worldwide, LLC, PSM Holdings, LLC, PSM Ventures, LLC, or any of its owners, directors, employees, representatives, volunteers, affiliates, successors, or assigns.

You or Your means the person whose signature appears on the bottom of this form.

ASSUMPTION OF RISK

You understand that there is a natural risk of injury, whether caused by Participant or someone else, in the use of or presence at a Play Street Museum location, the use of equipment and services at any Play Street Museum location, and participation in any Play Street Museum location related activities. These activities include but are not limited to, the use of any Play Street Museum location toys, equipment, exhibits, or materials, and/or Play Street Museum location events, private parties, community, school, or non-profit programs hosted by any Play Street Museum location.

You understand that the risk of injury includes, but is not limited to:

  • Injuries arising from the use of any Play Street Museum location or equipment, including any accidental or "slip and fall" injuries; and
  • Injuries or medical disorders, including, but not limited, to heart attacks, strokes, heart stress, head injuries, sprains, cuts, bruises, broken bones and torn muscles or ligaments, resulting from Your use of or presence at a Play Street Museum location l, Participant's use of equipment or services at a Play Street Museum location, or Your participation in any Play Street Museum activities;

You understand and voluntarily accept this risk on behalf of Participant.

You specifically acknowledge that, if you are not a parent or legal guardian of the Participant, that you have discussed the terms of this Agreement with the Participants parent or legal guardian and have been given the authority by the Participants parent or legal guardian to sign this Agreement on the Participants behalf.

You agree to specifically assume all risk of loss, theft or damage of personal property for the Participant while he or she is present at any Play Street Museum location, or participating in any Play Street Museum location related activity and defined above.

RELEASE OF LIABILITY

You specifically waive Your right and/or Participants right to bring or take any action against Play Street Museum as a result of any injury, loss, theft, or damage to You and/or Participant, including and without limitation, personal bodily or internal injury, economic loss or any other type of damage resulting from the negligence of Play Street Museum or anyone else using a Play Street Museum facility.

You agree to defend, indemnify, and hold Play Street Museum harmless against any claims arising out of the negligence or willful acts or omissions of You or Participant.

I understand that I need to monitor my child as the potential exists for there to be a choking hazard or other safety concern.

I approve the use of pictures taken at a Play Street Museum location, in which the Participant is part of, to be used on the Play Street Museum website, social, or print media, and marketing advertisements.

I hereby certify that I have read and understand this entire Agreement and agree to and accept the terms and conditions of this entire application.

Date: August 26, 2019

First Guest's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Guest'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*
Please help us identify our next Play Street Museum location by sharing your zip code with us

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*
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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