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In consideration of my minor child or ward (referred to herein as the “Participant”) being permitted to participate in any way in the activities conducted at My Play Village, LLC (“My Play Village”), I, on behalf of myself and my minor child or ward, our personal representatives, executors, administrators, assigns, and heirs, hereby agree as follows:

  1. I affirmatively represent that my minor child or ward is qualified, in good health and in proper physical condition to participate in the activities at My Play Village.
  2. I fully understand that the activities at My Play Village may involve risks and dangers of serious bodily injury (“Risks”), and that the Risks may be caused by my child or ward’s own actions, or inactions, the action or inactions of others participating in the activities, the condition in which the activities take place, or the negligence of other parties, and there may be other risks and economic losses either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks my minor child or ward may incur as a result of participation in the activities at My Play Village. I further acknowledge that I have been given the opportunity to ask questions about the activities at My Play Village from its staff and employees and that I have a full and complete understanding of the risks associated thereto.
  3. I hereby release, discharge, covenant not to sue and indemnify My Play Village and its employees, officers, agents, owners, representatives and assigns (collectively “Releasees”) from and against all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of Releasees or otherwise, including any claim for personal injury, property damage, death, or accident of any kind, arising out of or in any way related to my use or my child or ward’s use of the My Play Village facility and equipment, including but not limited to "slip and fall" injuries, and the use of the toys, materials, exhibits, designated play space, ladders, slides, stairs, climbing structures, outdoor playspace, and parking lot.
  4. I further agree that I shall comply with all posted safety signs, rules and verbal instructions as conditions for participating in activities at My Play Village and that I will monitor my minor child or ward at all times, as the potential exists for there to be a choking hazard or other safety concern.
  5. ​You agree to specifically assume all risks of loss, theft or damage of personal property for self and the the Participant while he or she is present at the My Play Village facility.
  6. COVID-19: By entering the facility, I hereby authorize MY PLAY VILLAGE LLC on behalf of myself, my heirs, representatives, executors, administrators, and assigns,  ON BEHALF OF MYSELF AND AS A 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 MY PLAY VILLAGE 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 MY PLAY VILLAGE LLC of any claim to illness that could be contracted in the community shared spaces throughout the facility.

I approve the use of pictures taken at My Play Village, in which the Participant is part of, to be used on the My Play Village website, social, or print media and marketing advertisements. If I do not approve of the use of these pictures for these purposes, I will notify a My Play Village employee upon arrival.

You specifically acknowledge that, if you are not a parent or legal guardian of the Participant(s), that you have discussed the terms of this Agreement with the Participants' parent or legal guardian and have been given the authority by the Participants' parent or legal guardian to sign this Agreement on the Participants behalf.

I HAVE READ THIS WAIVER, FULLY UNDERSTAND ITS TERMS, WARRANT THAT I AM AUTHORIZED TO ACCEPT ITS TERMS AND UNDERSTAND THAT I HAVE, WITHOUT INDUCEMENT, GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I INTEND THIS WAIVER TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT THE LAWS OF THE STATE OF ILLINOIS WILL CONTROL ITS TERMS.

I have read, understand and agree to the terms of this Waiver of Liability.

Today's Date: May 3, 2024

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 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*

**You specifically acknowledge that, if you are not a parent or legal guardian of the Participant(s), that you have discussed the terms of this Agreement with the Participants' parent or legal guardian and have been given the authority by the Participants' parent or legal guardian to sign this Agreement on the Participants behalf. 

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*
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 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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