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The Campus Play Studio Ltd.

Parent/Guardian Consent, Acknowledgement of Risk and Waiver Form

Consent, Acknowledgement of Risk and Waiver

1. Parent/Guardian Consent, Acknowledgements and Responsibilities

I hereby sign this Waiver in consideration of the opportunity to participate in any activities held at, or organized or directed by, The Campus Play Studio Ltd. (“Campus Play Studio”).

I understand, acknowledge, and accept the following, for myself and my Child:

(a) I am the Parent or Legal Guardian of the Child, or alternatively I am authorized to sign and execute this Waiver on behalf of the Child’s Parent/Guardian. 

(b) I have listed above any illnesses, allergies, and/or disabilities that may require special attention by the Campus Play Studio, its staff, agents, or authorized volunteers, and it is my responsibility to advise the Campus Play Studio, its staff, agents, or authorized volunteers in writing of any medical or health concerns pertaining to my child that may affect participation.

(c) The Child and I shall comply with all stated and customary policies, posted safety signs, rules and verbal or written instructions as conditions for participation in any activity or event at the Campus Play Studio. I agree that I shall be responsible for the Child’s failure to so abide. I agree that a failure by myself or the Child to do so may result in expulsion from the Campus Play Studio.

(d) The Child and I may participate in off-site activities including walks to and from a park with a playground, and risks of injury, both known and unknown, may arise from attendance and participation in such off-site activities. I, for myself and for the Child, willingly assume these and other risks that may arise due to other participants in such off-site activities.

(e) entry by myself or the Child as accompanied by any adult to the Campus Play Studio shall constitute consent to photograph and/or record me and/or the Child and any accompanying adult, and I consent to Campus Play Studio using any photograph, video or likeness of myself, the Child and/or any accompanying adult for the purpose of marketing and promotional use without payment or compensation.

(f) Campus Play Studio is not a licensed daycare or childcare service, and parent(s) or guardian(s) over the age of eighteen (18) years are obligated to remain at the premises to supervise the Child.

In signing this Waiver, I acknowledge that:

(a) I am not relying upon nor induced by any oral or written representations or statements made by Campus Play Studio, its staff and/or agents, or authorized volunteers other than those set out in this Waiver.

(b) I am legally competent to understand and complete this Waiver and am doing so without coercion.

2. Multi-Use Waiver

I hereby expressly authorize the Campus Play Studio to use this Waiver as a continuous, multi-use waiver for both ongoing access to the Campus Play Studio and special events hosted at, or organized or directed by, the Campus Play Studio.

3. Release and Indemnity

I accept full responsibility for any harm, injuries, or losses that may occur to the Child while participating in activities at the Campus Play Studio. I agree that the Campus Play Studio, its staff, agents, and authorized volunteers shall not be held responsible for any accidents and/or physical injury to the Child arising from the Child’s participation in any activities held at, or organized or directed by, the Campus Play Studio.

I, for myself, the Child, our heirs, assigns, representatives, and next of kin, hereby agree to hold harmless, release, waive, and indemnify the Campus Play Studio, its staff, agents, and authorized volunteers from: (1) any and all liability for any injury, harm or loss sustained to the Child or myself, regardless of how such injury, harm or loss is caused, resulting from the Child’s participation in an activity held at, or organized or directed by, the Campus Play Studio; and (2) any and all claims, suits, demands, torts and actions of any origin or type which may be brought against its staff or agents for which it or they may become liable by reason of any injury, loss, damage or death resulting from, occasioned to, or suffered by any person or any property, by reason of any act, neglect, or default of mine or of the Child. This indemnity shall include indemnification for legal costs incurred to enforce this Waiver.

4. Severability of Provisions

In the event that any clause, paragraph or provision in this Waiver should be deemed unenforceable or invalid, the remaining provisions shall remain in full force and effect and the offending clause, paragraph or provision shall be severed herefrom.


Today's Date: May 2, 2025

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Known Illnesses, Allergies, Disabilities:
First Participant's Signature*
Second Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Third Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Fourth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Fifth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Sixth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Seventh Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Eighth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Ninth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Tenth Participant's Name

First Name*

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

Known Illnesses, Allergies, Disabilities:
Parent or Guardian's Email Address

Email*

Confirm Email*
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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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Known Illnesses, Allergies, Disabilities:
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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