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Waiver and Liability Release

In consideration of being permitted by Raley’s to use the Something Extra® Play Area and facilities (“Play Area”) provided by Raley’s at Bel Air, 2760 E. Bidwell Street, Folsom, California, I, the undersigned, on behalf of myself and my minor children identified herein (collectively, “I”, “me”, or “my”), expressly agree and contract to the following:

I acknowledge that my participation in and use of the Play Area provided by Raley’s entails known and unknown risks that could result in physical or emotional injury, death, or damage to myself, my child or third parties.

The risks include, among other things:

cuts, bruises, strains and infection;
choking hazards from toys that might break or contain small parts;
tripping, falling off equipment, or other risks that might result in sprained joints, broken bones, concussions or more serious harm, up to and including death.

Use of the Play Area is purely voluntary and I elect to utilize these areas in spite of the risks. I agree to be solely responsible for the safety and wellbeing of myself and my child or children. I understand that Raley’s does not provide supervision, instruction, or assistance for the use of the facilities, toys, and equipment.

I agree to comply with all rules imposed by the company regarding the use of the facilities and equipment, including, but not limited to, those posted in and around the Play Area. I agree to refrain from using any equipment or toys in a manner inconsistent with their intended design and purpose.

To the fullest extent permitted by law, I hereby voluntarily fully release, discharge, covenant not to sue, and agree to defend, indemnify and hold harmless Raley’s, its owners, affiliates, subsidiaries, insurers, employees, officers, directors, agents, contractors, and any entity to which any such party owes a contractual indemnification obligation (collectively “Indemnified Parties”) from any and all claims, losses, demands, or causes of action, costs and expenses, including attorney’s fees, which are in any way connected with my use of the Play Area, including, without limitation, any claims which allege or prove negligent acts or omissions of the Indemnified Parties. This includes, without limitation, claims which allege or prove that the injuries and/or damage were caused by the Indemnified Parties’ sole negligence and/or claims which allege or prove that the injuries and/or damage were caused solely or partly due to negligent design, construction, condition, maintenance, or repair of the equipment or facilities.

                                   

This Waiver and Liability Release shall be effective and binding upon my heirs, next of kin, executors, administrator and Assigns, in event of my death.

By signing this agreement I waive my right to bring a court action to recover compensation or obtain any other remedy for injury to myself, my child, or my property.

I certify that I am eighteen (18) years or older and otherwise legally competent to sign this agreement.

 

I HAVE READ THE FOREGOING WAIVER AND LIABILITY RELEASE AND VOLUNTARILY EXECUTE THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENTS.  NO ORAL REPRESENTATIONS, STATEMENTS OR OTHER INDUCEMENTS TO SIGN THIS WAIVER AND LIABILITY RELEASE HAVE BEEN MADE APART FROM WHAT IS CONTAINED IN THIS DOCUMENT. I UNDERSTAND THIS IS A CONTRACT THAT AFFECTS MY LEGAL RIGHTS AND I SIGN IT OF MY OWN FREE WILL. THIS AGREEMENT SHALL, IN ALL RESPECTS, BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF CALIFORNIA, WITHOUT REGARD TO ITS CONFLICTS OF LAWS PRINCIPLES.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
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*

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*

Middle Name

Last Name*

Phone*
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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