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Agreement to Use Facilities and Services Provided & Waiver of Liability

In consideration of being allowed to enter the play area and/or participate in any party and/or program at Cupkins Play Cafe LLC, 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 or legal guardian of the participants(s) named below, or I have obtained permission from the parent/guardian of the participant(s) named below to execute this agreement on their behalf. I agree that the participant(s) named below and I shall comply with all posted safety signs, rules, and verbal instructions as conditions for participation in any free play, party and/or program at Cupkins Play Cafe LLC.

- I understand that inherent risk of injury or illness, though minimal, does exist. I, for myself, the children and on behalf of my and their heirs, assigns, personal representatives and next of kin, hereby waive, release and discharge Cupkins Play Cafe, LLC and its directors, officers, agents, employees, owners and representatives with respect to any and all losses, damages, injuries, expenses and claims, including without limitation suffered or incurred as a result of the children using Cupkins Play Cafe, LLC, due to any cause whatsoever, for personal injury, death or loss or damage to person or property, even if arising from the negligence of Cupkins Play Cafe, LLC or otherwise and hereby agree to indemnify and hold harmless Cupkins Play Cafe, LLC from and against any liability, losses, claims and damages resulting from the children playing at Cupkins Play Cafe.

- I am aware that there are inherent risks associated with participation in Cupkins Play Cafe programs, parties, and/or use of the play area, 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 other participants.

-If I observe any hazard during our participation, I will bring to the attention of the nearest Cupkins Play Cafe employee or official immediately.

- I and the child(ren) have no illness or injury that may affect the safe enjoyment of Cupkins Play Cafe, LLC by us or other guests. – Cupkins Play Cafe, LLC is not responsible for any lost or stolen items.

- I understand that Cupkins Play Cafe, LLC, may take photographs, video, or other physical or digitally recorded media on its premises at any time, the only exception being private areas of restrooms. I hereby grant Cupkins Play Cafe, LLC, the right to use my likeness in photographs, video, or other physical or digitally recorded media in any of its publications, including web- based publication, without payment or other consideration. I hereby assign full copyright of these photographs, video, or other physical or digitally recorded media to Cupkins Play Cafe, LLC, its licensees or assignees together with the right of reproduction either wholly or in part.

Additionally, I waive any right to royalties or other compensation arising or related to the use of any photographs, video, or other physical or digitally recorded media. By entering this facility, you are agreeing to the above terms and conditions. In addition you are also acknowledging that you and your child are free from any of the following symptoms: Nausea, Vomiting, Fever, Sore Throat, Runny Eyes, Coughing, Diarrhea, or any other illness of contagious nature. Please DO NOT ENTER if you or your child feel unwell.

Today's Date: August 14, 2022

First Participant's Name

First Name*

Last Name*
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*
Check to receive information, news, and discounts by e-mail.
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*
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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