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My Little Paris
416 E. Las Tunas Dr, Unit C
San Gabriel, CA 91776

 

NEW CUSTOMER FORM

Assumption of Risk, Waiver, and Release from Liability

This is a legally binding agreement that you should read carefully before signing. By signing this document, you are waiving certain rights, including the right to bring a lawsuit to recover damages if you are injured while participating in any activity at My Little Paris. You have the right to refuse to sign this form and released parties have the right to refuse to let your child to participate if you do not sign this form.

In Consideration of being allowed to enter the play area and/or participate in any party and/or program at My Little Paris, the undersigned, on his or her behalf, and on the behalf of the participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:

I represent that I am the parent of legal guardian of the participant(s) names below, or I have obtained permission from the parent/legal guardian of the participant(s) names below to execute the agreement on their behalf.  I agree that the participant(s) named below and I shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions as conditions for participation in any party and/or program at My Little Paris.  In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest My Little Paris employee or official immediately.  I understand that I am responsible for my child’s safety and behavior at all times each visit.  I understand that my child will remain in my clear view at all times during my visit.

I am aware that there are inherent risks associated with participation in My Little Paris parties, program and I, on behalf of myself and the participant(s) named below, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of participants.

I, for myself and the participant(s) named below, accept personal responsibility for the damages following such injury, permanent disability or death, including those resulting from the negligence of My Little Paris.  I, for myself and the participant(s) named below, knowingly and freely assume all risks, both known and unknown, even those arising from the negligent acts or omission of others and assume full responsibility for our own participation.

I, for myself and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, agree to indemnify and hold harmless, My Little Paris management, their affiliates, employees, other participants, and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our participation in any and all My Little Paris programs, activities, parties, and the use of the play areas.

I, for myself and the participant(s) named below, will read and abide by all posted rules including, but not limited to: wearing socks inside the play area (grip socks are highly recommended), ensuring only children within the age limit (2 years and under) enter the baby area, ensuring only children 2 years and above are playing outside the baby area, refraining from running, and refraining from the throwing or misusing toys in any way. I also understand that there is absolutely no food, drinks or gum allowed inside of the play areas at any time. I understand that in order to play, my child(ren) must be well and free of any communicable/contagious illnesses.

I understand that I am responsible for the monitoring of the participant(s) named below during the entirety of our visit.

NOTE: We reserve the right to deny service to any child or adult who may appear ill, and require a doctor’s note for any ill child to return. We also reserve the right to ask any guest who does not adhere to this signed agreement to leave without refund.

I acknowledge the contagious nature of the Coronavirus/Covid-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that My Little Paris has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.  By visiting My Little Paris, I, for myself and the participant(s) named below, voluntarily assume all risks related to exposure to the Coronavirus/Covid-19.

I grant permission to My Little Paris and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release My Little Paris and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that are given at the facility, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

I Agree

September 18, 2021

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*
Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
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*

Last Name*

Relationship*

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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