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Social Play Haus Waiver Form

Assumption of Risk, Waiver, and Release from Liability

located at: 200 Express St., Suite 100, Plainview, NY 11803

This Assumption of Risk, Waiver, and Release of Liability covers all activities at Social Play Haus.

1. Risk Factors‐ I understand and acknowledge that the use of the facilities at Social Play Haus involves risks including, but not limited to the following: bodily injury including but not limited to permanent disability, paralysis, and death. These risks may result from a variety of circumstances including the misuse of equipment or facilities.

2. Assumption of Risk‐ I am choosing to use the facilities at Social Play Haus at my own risk. I understand and acknowledge that the activities which I am or/and (any minor children for which I am the Parent, legal guardian, or otherwise responsible, any heir’s personal representative) about to voluntarily engage in as a participant and/or volunteer bears certain know risks and unanticipated risk could result in injury, death, illness or disease, physical or mental, or damage to myself, or to spectators or third-parties. I assume full responsibility for all risks that may arise from using the facilities at Social Play Haus or from participating in activities at Social Play Haus.

3. Acknowledgement of Policies and Procedures‐ I acknowledge that I have read, know, and agree to all of the policies and procedures relating to the use of the facilities at Social Play Haus. I agree to comply with all rules, regulations, and policies at Social Play Haus. I understand Social Play Haus reserves the right to revoke or terminate my use of the facilities at Social Play Haus for any violation of rules, regulations, or policies.

4. Release, Indemnify, and Defend‐ I hereby release, waive, discharge, and hold harmless Social Play Haus and all employees past or present from any claims, suits, liabilities, judgments, costs and expenses for any property damage, loss or theft, personal injury or illness, death, or other loss arising from the use of Social Play Haus 

5. Waiver‐ I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. I am releasing unknown future claims.

6. Payment for damages‐ I agree to pay for any and all damages to any property or equipment as a result of my or my family’s willful actions, neglect, or recklessness and agree to be held liable for all such costs associated with such damages.

7. Representatives‐ I enter into this agreement for myself as well as for my heirs, assigns, and legal representatives.

8. Insurance‐ I understand that I am solely responsible for any medical, health, or personal injury costs relating to my use of Social Play Haus and its facilities. I understand that I am strongly encouraged to have a medical physical exam and purchase health insurance prior to my use the facilities at Social Play Haus.

9. Arbitration – All parties to this agreement agree to mediate, in good faith, any dispute prior to initiating arbitration or litigation based on the laws of the state of New York. The prevailing party in the event of arbitration or litigation shall be entitled to costs and reasonable attorney fees.

10. I hereby grant Social Play Haus permission to use myself or my children in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

11.  I certify that my responses to the safety & Health questions are accurate.

12.  By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Social Play Haus and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Social Play Haus may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance or participation in Social Play Haus (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Social Play Haus, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in Social Play Haus activities.

I am the parent or legal guardian of the above-named minor.  I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily on behalf of myself and any minor child/children for which I am the parent, legal guardian, or otherwise responsible for, named below:

Date: July 25, 2021

 

First Players Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Players Date of Birth*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Care Giver Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
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 Care Giver Name

First Name*

Last Name*

Phone*
Parent or Care Giver Date of Birth*
I certify that I am 18 years of age or older
Parent or Care Giver 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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