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Rock & Play LLC 

My son/daughter/ward ("child") has my permission to utilize Rock & Play LLC (indoor play area) Play Facilities and to participate in Rock & Plays Activities,

which include but is not limited to, free or paid for use of its sandbox, soft play area, interactive activity area, slides, play stations, cafe, parties and or special events ("play facilities and activities").

By this permission I agree to release Rock & Play from any and all claims arising from my child's use of Rock & Play's facilities and activities. I understand that the play facilities and activities involve risks

of seriouse bodily injury, including permanant disability, paralysis, and death, which may be caused by my childs actions or interactions those of others participating in play facilities and activities,

the conditions in which the play facilities and activities take place, or the negligence of the "releases" name below. I further understand that there may be other risks, either not known to me or readily

foreseeable at this time, and I fully accept and assume all such risks and all responsibility for losses, costs, and damages that I incur as a result of my child's participation in play facilities and activities

at Rock & Play. 

My Childs participation at Rock & Play Indoor play is purely voluntary and I voluntarily agree to assume all risks involved in this activity.

 

I have read the above Waiver and Release and by signing it I agree that it is my intention to exempt and relieve Rock & Play LLC from any liability for personal injury, personal property damage or wrongful death caused by negligence or any other case.

 

April 22, 2021     

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
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 Guardian's Name

First Name*

Middle 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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