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RELEASE OF LIABILITY

 

In consideration of being allowed to enter the play area and/or participate in any party and/or program at honey hippo. Play Cafe, the undersigned, on his or her behalf, and on the behalf of the participant(s) identified above, acknowledges, appreciates, and agrees to the following conditions:

I represent that I am the parent or legal guardian of the participant(s) named below, or I have obtained permission from the parent/legal 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 will all stated and customary terms, posted safety signs, and verbal instructions as conditions for participation in any party and/or program at honey hippo. Play Cafe. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest honey hippo. Play Café employee or official immediately. I understand that I am responsible for the safety and behavior of the participant(s) named below at all times, each visit.

I am aware there are inherent risks associated with participation at honey hippo. Play Café programs and parties, including, but not limited to falling, slipping, collisions with objects or other person(s). On behalf of myself and the participant(s) named below, I knowingly and freely assume all such risk, both known and unknown, including those that may arise out of ordinary negligence or other participants; and,

I, for myself, and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, LT Shake N Bake, LLC, honey hippo. Play Cafe, honey hippo. Play Café management, their affiliates, officers, members, agents, employees, volunteers, 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 honey hippo. Play Cafe programs, activities, parties, and the use of the play area.

I acknowledge honey hippo. Play Cafe may photograph or otherwise record events or activities and such photographs or recordings may include myself and the participant(s) named above.  I grant honey hippo. Play Cafe a royalty-free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use such photographs or recordings, which may be edited or modified, in honey hippo. Play Café’s advertisements, promotions, displays, marketing, or for other such purposes.

By signing this document, you may be waiving your legal right to a jury trial to hold the provider legally responsible for any injuries or damages resulting from risks inherent in the sport or recreational opportunity or for any injuries or damages you may suffer due to the provider’s ordinary negligence that are the result of the provider’s failure to exercise reasonable care.

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*
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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last 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.


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*

Relationship*

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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