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RELEASE AND WAIVER

I, for myself and other Participants listed below, sign this Release and Waiver for the opportunity to use the facility at Play Town Square and/or to participate in any parties or activities at/by Play Town Square and:

Acknowledge and understand that there are dangers and risks associated with participation at Play Town Square and any related activities and agree to assume all risk of loss, property damage, and personal injury, including death, that may be sustained as a result of participation at Play Town Square, whether caused by the negligence of Play Town Square, its owners, employees, agents or otherwise.

Agree to release, defend, indemnify and hold harmless Play Town Square, its owners, employees and agents from all liability incurred by participation in activities at Play Town Square, whether caused by Play Town Square its owners, employees, agents or otherwise.

Understand that adult supervision of each child by that child’s parent or authorized caregiver is required and at all times. Play Town Square shall not be liable for any injury resulting from the absence of adult supervision.

Understand and acknowledge that Play Town Square may use any photography/video taken at Play Town Square in social or print media, marketing advertisements or on its website and authorize the use of any photograph/video without the express written permission of those included within the photograph/video.

I hereby certify that I am the parent, guardian, or authorized caregiver of the Participant(s) whose name(s) appear below, and I have the authority to sign this Release and Waiver on behalf of the Participant(s).

Today's Date: November 22, 2019

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*
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 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*
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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