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Release of Liability for 123 Playroom

As Consideration for being allowed to enter the play area, our facility and and/or Participate in any part and/or program at 123 Playroom, a 123 Playroom Limited Liability Company, the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified below, acknowledge, appreciates, understands, and agrees to the following: 

1. I acknowledge that I am the parent or legal guardian of the Participant(s) named below (entering 123 Playroom with me) or I have obtained permission from the parent/legal guardian of the Participant(s) named below to execute this agreement on their behalf. 

2. I acknowledge and understand that there are known, and unknown risks associated with participation in 123 Playroom activates, use the facility, the use of the play area and equipment, and interaction with other customers and employees including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death; transmission of bacteria, viruses, germs, and diseases. 

3. I, for myself and the Participant(s) named and in my care, willingly assume all risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume. 

4. I agree that Participant(s) named and in my care, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in the use of the facility, the play area, any party events and/or program and 123 Playroom. 

5. I, for myself, the Participant(s) named in my care, our heirs, assigns, representatives, of next of kin agree to hold harmless, release, waive, and indemnify the independent owner(s) of this 123 Playroom facility, 123 Playroom Limited Liability Company, their predecessors, parent, subsidiaries, and affiliates, officers, equipment manufacturers, employees, and sponsoring agencies from any and all injures, disability, death or loss, liabilities or damages from participation , and transmission of any disease, germs, virus, and bacteria. 

6. I additionally agree to indemnify the independent owner(s) of 123 Playroom, 123 Playroom Limited Liability Company, their predecessors, parent, subsidiaries and affiliates, officers, equipment manufacturers, employees, and sponsoring agencies for any defense cost or expense arising from any and all claims, injuries, liabilities or damages arising from participation at 123 Playroom. 

7. I am of physical ability to participate and am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion. 

8. The invalidity or unenforceability of any provision of this agreement shall not affect the validity or enforceability of any other provision of this agreement, which shall remain in full force and effect. 


September 17, 2024

First Participant's Name

First Name*

Last Name*
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Select the number of Minors participating:
1 minor
2 Minors
3 Minors
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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