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My Jungle Gym Inc. 

ASSUMPTION OF RISK, WAIVER, INDEMNIFICATION, HOLD HARMLESS AND RELEASE OF LIABILITY AGREEMENT 

My Jungle Gym Inc. is a facility that has amusement equipment for use in, but not limited to; jumping, climbing, tumbling, running, throwing, bouncing, swinging and playing. Such activities can cause injury. 

I acknowledge and understand there are inherently dangerous risks associated with participating in the activities 
and facilities at My Jungle Gym Inc. that may cause injury or damage including, but not limited to; bumps, bruises, scrapes, cuts, contusions, fractures, paralysis or death. I willingly assume all risks on behalf of myself and any children listed below as participants or guests.

I represent that I am the parent, legal guardian or have obtained the authority or permission of the parent(s) or legal guardian of the following named child participant(s) to execute this agreement on their behalf. 

I, on behalf of myself, my heirs, next of kin or executors, waive, release, and discharge My Jungle Gym Inc., its owners, officers, agents and employees and agree to hold harmless from all liability for its negligent acts or omissions resulting from participation in any and all activities that result in loss or damage to property and or any and all activities that cause physical or emotional injury to me or my child or children. I assume all costs associated with such injury or loss including, but not limited to, property loss, medical and legal expense. 

I agree to indemnify My Jungle Gym Inc., its owners, officers, agents, affiliates and employees for any defense cost or expense from any and all claims, liabilities, injuries or damages arising from participation or attendance. 

I understand and agree that this agreement is valid for this visit and any future visits and has no time limitations or expiration. 
I approve, on behalf of myself and the participants identified above, the use of any photographic images taken by My Jungle Gym employees, representatives or equipment in marketing materials, including website or print media. 

I am of legal age, mentally competent and understand that I am giving up any right to bring a legal action or assert a claim against My Jungle Gym Inc., its owners, officers, agents, affiliates and employees for its negligence or for any defective product on its premises.

Date: May 26, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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*
Participant's 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 My Jungle Gym 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*

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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