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RISK ACKNOWLEDGEMENT AND WAIVER

 

ACKNOWLEDGE AND AGREE that the use of the LITTLE BEANS CAFE EVANSTON LLC facility and equipment has inherent risks. I am the legal guardian or assigned caretaker of the below listed minor on behalf of myself and said listed minor, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants. I agree that I shall comply with all, posted safety signs, rules, and verbal instructions as conditions for participation in activities at LITTLE BEANS CAFE EVANSTON LLC. If I observe any hazard during my participation, I will bring it to the attention of the nearest LITTLE BEANS CAFE EVANSTON LLC employee.

On behalf of myself, my heirs, representatives, executors, administrators, and assigns, I, ON BEHALF OF MYSELF AND AS LEGAL GUARDIAN OR ASSIGNED CARETAKER OF A MINOR CHILD (LISTED BELOW) HEREBY DO RELEASE, INDEMNIFY, AND HOLD HARMLESS LITTLE BEANS CAFE EVANSTON LLC, its officers, agents, independent contractors, insurance companies, landlords, instructors and employees from any cause of action, claims, or demands of any nature whatsoever, including but not limited to, a claim of negligence, which my minor child or I, my heirs, representatives, executors, administrators, and assigns may now have, or have in the future against LITTLE BEANS CAFÉ EVANSTON LLC, on account of personal injury, property damage, death, or accident of any kind, arising out of or in any way related to my use of the LITTLE BEANS CAFÉ EVANSTON LLC facility and equipment, including but not limited to the LITTLE BEANS CAFÉ EVANSTON play space, outdoor play areas, gym space, general parking lot, land area, and café area, whether that use is supervised or unsupervised, however the injury or damage is caused, including, but not limited to the negligence of LITTLE BEANS CAFÉ EVANSTON LLC, its officers agents, independent contractors, instructors, insurance companies, landlords, instructors and employees.

By entering the facility, I hereby authorize LITTLE BEANS CAFÉ EVANSTON LLC on behalf of myself, my heirs, representatives, executors, administrators, and assigns, ON BEHALF OF MYSELF AND AS LEGAL GUARDIAN OR ASSIGNED CARETAKER OF A MINOR CHILD (LISTED BELOW) the authority to deny access, request to immediately leave the premises, and/or call health officials if myself, my guests, or any accompanying minors show symptoms of illness that could be associated with COVID-19 or other like illnesses. I also allow LITTLE BEANS CAFÉ EVANSTON LLC the authority to take any person under my supervisions body temperature to screen for potential illness using a thermal no-contact temperature device, including any minor. Additionally, I hereby indemnify LITTLE BEANS CAFÉ EVANSTON LLC of any clam to illness that could be contracted in the community shared spaces throughout the facility. 

I understand that entering this facility is done so at my own risk and I do not and will not hold LITTLE BEANS CAFE EVANSTON LLC responsible for contracting any illness that myself or any minor under my care may contract, be it either COVID-19 or any other illness. 

Today's Date: March 25, 2023


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 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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Details

60626
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*

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 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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