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All guests entering The Little Lounge play area must have an active signed waiver, including all party guests.

AGREEMENT

The child(ren) named above (“Participant”) desires to participate in the following programming: imaginary, gross motor, sensory, and fine motor play including but not limited to running, walking, climbing, sliding, swinging, jumping, and use of non-motorized ride-on vehicles (collectively, the “Activity”) provided by The Little Lounge LLC, a limited liability company organized under the State of New York (the “Company”) at 2898 Westinghouse Road, Suite 560, Horseheads, NY 14845 (the “Premises”). In consideration of being permitted by the Company to enter the Premises and participate in the Activity and in recognition of the Company's reliance hereon, the undersigned parent or legal guardian of the Participant (referred to as “I” or “me” and together with the Participant “we”, “our”, or “us”), on his or her behalf, and on behalf of the Participant, acknowledges and agrees to all the terms and conditions set forth in this agreement (this “Agreement”).

1.              I represent that I am the parent or legal guardian of the Participant. We agree that we shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any Activity at the Premises. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Company employee or official immediately. I understand that while I am at the Premises, I am responsible for my child’s safety and behavior at all times. The information on this form is complete and accurate, and I have provided the Company with all of the necessary information to properly care for the Participant.

2.              Any items brought from home must be labeled with the Participant’s name. Toys from home are not permitted. The Company is not responsible for any lost, damaged, or stolen items. 

3.              If I am leaving the Participant at the Premises, it is my responsibility to arrange for the Participant to be picked up from the Company within the three hour time limit. If the Participant is not picked up on time and attempts to contact me have failed, another “Authorized Person” will be contacted. In order to pick up a Participant from the Company, all guardians and Authorized Persons must provide photo identification. In the event no Authorized Person can be reached, the Company staff will contact Child Protective Services and/or police officials for further instructions. 

4.              In the event of an emergency, the Company will attempt to contact me. If I cannot be reached, the Company is authorized to contact one of the above “Emergency Contacts”. In the event no Emergency Contact can be reached, the Company is authorized to act for me according to their best judgment in obtaining emergency medical treatment for any Participant. Because some children may be allergic, Participant may not bring any peanuts, peanut butter, or other nuts onto the Premises. 

5.              In the event the Participant needs to use the bathroom, I give the Company staff permission to accompany them if necessary to ensure the Participant’s safety. If I am not comfortable with this, I will let staff know in writing upon drop-off. I hereby represent that the Participant is toilet trained and that they can use the bathroom with independence.

RELEASE AND WAIVER OF LIABILITY

6.              We are aware and understand that the Activity is a potentially dangerous activity and involves the risk of personal or psychological injury, pain, suffering, temporary or permanent disability, death, property damage, and/or financial loss. We are also aware of the contagious nature of bacterial and viral diseases, including COVID-19 (collectively, the "Disease") and the risk that we may be exposed to or contract the Disease by being on the Premises and engaging in the Activity, which may result in illness, personal or psychological injury, pain, suffering, temporary or permanent disability, death, property damage, and/or financial loss. We acknowledge that these risks may result from or be compounded by the actions, omissions, or negligence of Company employees or others, including negligent emergency response or rescue operations of the Company. We understand that the Company cannot guarantee that we will not be injured or become infected with the Disease while on the Premises or during our participation in the Activity and that being on the Premises and engaging in the Activity may increase our risk of contracting the Disease. NOTWITHSTANDING THESE RISKS, WE ACKNOWLEDGE THAT WE ARE VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGERS INVOLVED. WE HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF ILLNESS, PERSONAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, TEMPORARY OR PERMANENT DISABILITY, DEATH, PROPERTY DAMAGE, AND/OR FINANCIAL LOSS ARISING THEREFROM, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE.

7.              We hereby expressly waive and release any and all claims now known or hereafter known against the Company and its officers, directors, manager(s), employees, agents, affiliates, shareholders, members, successors, and assigns (collectively, "Releasees") on account of personal or psychological injury, illness, pain, suffering, temporary or permanent disability, death, property damage, or financial loss arising out of or attributable to our being on the Premises or participating in the Activity, whether arising out of the ordinary negligence of the Company or any Releasees or otherwise.We covenant not to make or bring any such claim against the Company or any other Releasee and forever release and discharge the Company and all other Releasees from liability under such claims.

8.              We confirm that, except as disclosed to the Company in writing, we are: (a) in good health and in proper physical condition and do not have any medical or other conditions that would impair our ability to participate in the Activity; and (b) not experiencing symptoms of the Disease (such as cough, shortness of breath, or fever, do not have a confirmed or suspected case of the Disease, and have not come in contact in the last 14 days (or such other time period as New York State guidelines recommend) with a person who has been confirmed to have or suspected of having the Disease. We will comply with all federal, state, and local laws, orders, directives, and guidelines related to the Activity and the Disease while on the Premises or participating in the Activity, including, without limitation, requirements related to hand sanitation, social distancing, and use of face coverings and safety equipment. We will also follow all instructions, recommendations, and cautions of the Company at all times. If at any time we believe conditions to be unsafe, that we are no longer in proper physical condition to participate in the Activity, or we begin experiencing symptoms of the Disease, we will immediately discontinue further participation in the Activity. We acknowledge that the Company is relying on these statements to allow us to participate in the Activity.

9.              I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorneys' fees, fees, the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by and/or awarded against the Company or any other Releasees arising out of or resulting from any claim of a third party related to our being on the Premises or participating in the Activity, including any claim related to my own negligence or the ordinary negligence of the Company.

10.           We hereby consent to receive medical treatment deemed necessary if we are injured or require medical attention during our participation in the Activity. We understand and agree that we are solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. We hereby release, forever discharge, and hold harmless the Company and all other Releasees from any claim based on such treatment or other medical services.

11.           We grant permission to the Company and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of us, or members of our family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. We hereby release the Company and its legal representatives for all claims and liability relating to said images or video. Furthermore, we grant permission to use our statements that are given at the facility, with or without our name, for the purpose of advertising and publicity without restriction. We waive our right to any compensation for any of the above-described material.

12.           This Agreement constitutes the sole and entire agreement of the Company and us with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and us and our respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of New York without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Chemung County, New York and we hereby consent to the exclusive jurisdiction of such courts. The Premises shall not be deemed a “place of public amusement and recreation” or other “similar establishments offering recreational activities” as those terms are used in N.Y. Gen. Oblig. Law § 5-326. Additionally, the Activity shall not be deemed a recreational activity as that term is used in N.Y. Gen. Oblig. Law § 5-326.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.

 

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*
Parent or Guardian's Email Address

Email*

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

In consideration of being permitted by the Company to enter the Premises and participate in the Activity and in recognition of the Company's reliance hereon, the undersigned parent or legal guardian of the Participant (referred to as “I” or “me” and together with the Participant “we”, “our”, or “us”), on his or her behalf, and on behalf of the Participant, acknowledges and agrees to all the terms and conditions set forth in this agreement (this “Agreement”).



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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