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Registration

 

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. 

I further acknowledge that Recess Playspace LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Recess Playspace LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.

I voluntarily seek services provided by Recess Playspace LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I attest that:

* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

* I have not traveled internationally within the last 14 days.

* I have not traveled to a highly impacted area within the United States of America in the last 14 days.

* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. 

* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold Recess Playspace LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Recess Playspace LLC. I understand that this release discharges Recess Playspace LLC from any liability or claim that I, my heirs, or any personal representatives may have against the business with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Recess Playspace LLC. This liability waiver and release extends to the salon together with all owners, partners, and employees.

I Agree

Classes are scheduled based on demand and by age/grade. 
A variety of classes will be offered throughout the week.

 

.          Today's Date: September 20, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Third Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Fourth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Fifth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Sixth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Seventh Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Eighth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Ninth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Tenth Participant's Name

First Name*

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

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
Participant's 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 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*
Where did you hear about us?

Answer here
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Grade

School

Doctor

Phone

Allergies/Medications
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant RECESS PLAYWORKS permission to use my or my child(ren)'s likeness in a photograph in any and all of its publications, including but not limited to all of RECESS PLAYWORKS's printed and digital publications. I understand and agree that any photograph using my likeness will become property of RECESS PLAYWORKS and will not be returned. I acknowledge that since my participation with RECESS PLAYWORKS is voluntary, I will receive no financial compensation. I hereby irrevocably authorize RECESS PLAYWORKS to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing RECESS PLAYWORKS's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RECESS PLAYWORKS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*
No
Yes
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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