Loading...

This waiver must be completed by a parent and/or guardian of any minors who participate in activities at Keystone Kidspace.

Keystone Kidspace Release and Waiver

This Release and Waiver contains a release of claims. Please read it carefully before signing. I/we acknowledge that I/we have received, read, understood and agree to this Release and Waiver and I/we voluntarily sign this Release and Waiver on behalf of my/our minor child and myself/ourselves as parent(s) and/or guardian(s) of said child.

For and in consideration of my/our child, or the child under my/our care, being permitted by Keystone Kidspace to participate in various interactive exhibits, programs, activities and classes (collectively, “Activities”) at Keystone Kidspace, 369 North George Street, York, Pennsylvania 17401 (the “Facility”), I/we, as parent(s) and/or guardian(s) of said child, hereby agree that:

I/we and my/our child (or the child under my/our care) agree to abide by the rules and regulations established by Keystone Kidspace and to follow the direction of Keystone Kidspace’s representatives at the Facility.

I/we understand that participation in the Activities at the Facility may expose the child to a variety of hazards and risks, foreseen and unforeseen. These hazards and risks include, but are not limited to, injury and property damage (“Injuries and Damages”). I/we understand that Injuries and Damages can arise as a result of unintended error or otherwise, from natural causes, physical conditions, science experiments, exhibits, classes and activities at Keystone Kidspace.

I/we, intending to be legally bound by this Release and Waiver, agree that:

Participation in the Activities at Keystone Kidspace is voluntary and I/we, for and on behalf of said child, voluntarily assume all risks associated with participation in the Activities at Keystone Kidspace, and I/we hereby release Keystone Kidspace and its employees, representatives, volunteers and agents from any and all claims, demands, liabilities, lawsuits, causes of action, costs and expenses whatsoever arising from said child’s participation in the Activities. I/we understand that Keystone Kidspace does not assume any responsibility for any Injuries and Damages arising from or connected with participation in any of the Activities at Keystone Kidspace or otherwise.

 

Parental Consent Photo Publication

Keystone Kidspace does not publish photographs of minor children/youth without the consent of a parent or guardian. If you are willing for your child’s photo(s), taken at events or activities of Keystone Kidspace, to be published, we ask that you read this consent form, then sign and date it. Please note that we DO NOT publish the NAMES of individual minors and are asking for consent to publish images only.

Keystone Kidspace has my permission to use photographs of my minor child, or the child for whom I am legal guardian, taken at Keystone Kidspace events and activities in print form and/or electronically, including on the Keystone Kidspace website.

Date: October 17, 2021

 

 

First Participant's Name

First Name*

Middle 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*

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*
Check to receive information and news from Keystone Kidspace by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Middle Name

Last Name*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!