Loading...

Lemon Rose Play Cafe Participation Agreement, Liability Waiver, and Policies 

1. Parties & Consideration 

I, as the parent or legal guardian of the child/children named below (each a “Participant,” collectively the “Participants”), in consideration of the Participants being permitted to engage in activities at Lemon Rose Play Cafe, agree to the following terms and policies. This Agreement applies to all minors under the care of the signing parent/guardian while on the premises, whether or not formally registered. 

2. Activities Defined 

Activities include all play, educational, and recreational services provided by Lemon Rose Play Cafe, an indoor play space and café. 

This waiver applies to all activities, events, programs, classes, and services offered by Lemon Rose Play Cafe, including but not limited to scheduled and unscheduled activities, before and after program hours, transitions between activities, and the use of all facilities (including play areas, café spaces, restrooms, and entry/exit areas), whether on or off the premises, including travel to and from the facility. 

3. Supervision & Safety Rules 

I understand that employees of Lemon Rose Play Cafe are not responsible for supervising Participants; it is my responsibility to supervise minors in my care outside of drop-off programs. 

I, and the children under my care, agree to follow all safety rules and play guidelines posted on lemonroseplaycafe.com, which may change over time. I have reviewed them prior to participation. 

4. Drop-Off & Pick-Up Policies 

All drop-offs, for specified drop off events, must bring a full change of clothes each day, and a water bottle or cup labeled with the child's first and last name. One snack will be provided any additional snacks must be labeled. 

Participants may NOT be dropped off more than 5 minutes before the start of an activity. 

Participants may NOT be picked up more than 5 minutes after the end of an activity. Late pickups will incur a $1 per minute fee after 1:05 PM. 

Parent/guardian agrees to have a responsible adult available to pick up the Participant within 30 minutes of contact in case of illness, injury, behavioral issue, or emergency closure 

5. Snack Policy 

Each Participant will receive 1 snack during activities. This does not pertain to ‘Open Play’ hours 

Parents may opt to: 

Purchase additional snacks on-site, or 

Leave spending money on their child’s account. 

Allergens: 

I acknowledge that Lemon Rose Play Cafe may provide or allow snacks that contain or have been in contact with common allergens. I assume all responsibility for monitoring my child’s dietary restrictions and release Lemon Rose Play Cafe from liability related to allergic reactions.

6. Sick Policy 

Participants must be symptom-free (fever, vomiting, diarrhea, rash) for at least 24 hours without medication before attending. 

If a child appears ill, staff may deny entry. 

7. Medication Policy 

Only emergency medications (EpiPens, inhalers) will be administered, and must be clearly labeled with written instructions by the guardian. If any incident occurs where emergency medication is administered, we will contact 911 and the guardians of the child. 

I release Lemon Rose Play Cafe from liability for any outcome resulting from emergency medical treatment provided in good faith. 

Daily medications will not be administered. 

8. Behavior Policy 

Lemon Rose Play Cafe has a zero-tolerance policy for physical aggression, violence, or unsafe behavior. 

Repeated incidents may result in dismissal without refund. 

All fees paid are non-refundable, including but not limited to absences due to illness, voluntary withdrawal, or dismissal for behavior policy violations. 

9. Potty Accidents 

If a child has an accident and cannot be cleaned with available resources, the parent/guardian will be contacted for early pickup. Repeat incidents may result in refusal in any drop off programs for the short future. 

10. Personal Items 

Toys, electronics, and valuables should not be brought. 

Lemon Rose Play Cafe is not responsible for lost or damaged personal items. 

11. Property Damage 

Parent/guardian is financially responsible for any damage to property caused by the Participant. 

12. No Refund Policy 

All fees paid are non-refundable, including but not limited to absences due to illness, voluntary withdrawal, or dismissal for behavior policy violations. 

13. COVID-19 Warning & Assumption of Risk 

An inherent risk of exposure to COVID-19 exists in any public place. By visiting Lemon Rose Play Cafe, you voluntarily assume all risks related to COVID-19. I understand that activities also carry the risk of serious injury or death, including but not limited to scratches, bruises, sprains, concussions, paralysis, and other injuries. I acknowledge that Lemon Rose Play Cafe cannot eliminate all risks and I assume them knowingly on behalf of myself and my child. 

I understand that, OIB Play Cafe LLC, DBA Lemon Rose Play Cafe cannot eliminate all risks or guarantee the safety of the Participants while Participants participate in the Activities. I have made

my own investigation of these risks, understand these risks, and assume them knowingly and willingly on behalf of myself and my minor Participant child. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, for myself and any minor Participant child, and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any sickness or injury arising out of or related to the Activities. 

By initialing each key section, I acknowledge that I have read and understood the Assumption of Risk, Release of Liability, Indemnification, Medical Treatment Authorization, Photo Release, and all Policies contained herein. 

Cancelation 

Lemon Rose Play Cafe is not responsible for cancellations or closures due to events beyond its control, including but not limited to weather, power outages, or public health directives. No refunds or credits will be issued in such cases. 

14. Release of Liability & Agreement Not to Sue 

RELEASE, DISCHARGE & AGREEMENT NOT TO SUE – I, for myself and any minor Participant child and our respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue Lemon Rose Play Cafe or its managers, members, employees and/or other agents, for any sickness, injury to or death of any Participant arising, directly or indirectly, from participation in the Activities. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of Lemon Rose Play Cafe and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract or otherwise.


15. Indemnification 

Indemnification And Hold Harmless – I agree to indemnify OIB Play Cafe LLC and hold Lemon Rose Play Cafe harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any party as a result of or arising out of my or my minor Participant child’s involvement in the Activities and agree to reimburse Lemon Rose Play Cafe for any such costs, expenses and fees as they are incurred. 

In the event of any legal action arising under this Agreement, the prevailing party shall be entitled to recover its reasonable attorney’s fees and costs from the other party. 


16. Permissions & Legal Agreements 

Security Cameras 

I understand that security cameras installed around and within Lemon Rose Play Cafe’s facility are for the safety of all participants and may be referenced should any incidents or injury occur. 


 

Photo Release 

I grant Lemon Rose Play Cafe permission to use any photographs, video, or sound bites obtained of me or any minor Participant child at Lemon Rose Play Cafe’s facility for any legal use including but not limited to: publicity, advertisement and web content. I understand that no royalty or other compensation shall be payable to me or the minor Participant by reason of such use. 


Medical Treatment Authorization 

In the event of an emergency, I authorize staff to seek emergency medical treatment for my child and accept responsibility for related costs. 


17. Certification & Consent 

I certify that I am the parent/legal guardian of the Participant(s) named below and that I have read, understand, and agree to all provisions of this Agreement. I understand the risks involved and am signing this document voluntarily. This Agreement has no expiration date. 

18. Governing Law & Jurisdiction 

This Agreement shall be governed by and construed in accordance with the laws of the State of North Carolina. Any dispute arising under this Agreement shall be brought exclusively in the state or federal courts located in Brunswick County, North Carolina. 

The parties agree to attempt to resolve any dispute arising under this Agreement through mediation prior to initiating litigation. 

19. Severability 

If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. 

20. Entire Agreement 

This document contains the entire agreement between the parties. No oral statements or representations are binding unless contained in this written agreement. 


First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Check to receive our newletter, special announcements, and discounts by e-mail. WE NEVER SEND SPAM!
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Authorized Pick Up Person
Is anyone other than yourself allowed to pick up your child?
Allergies, Medical Conditions, or Behavioral Concerns
Any Allergies, Medical Conditions, or Behavioral Concerns? *
Potty Trained
Is your child potty trained?*
Yes
No
Are we allowed to enter the bathroom with your child if needed?
Are we allowed to enter the bathroom with your child if needed?*
No
Yes
Food/Drinks
Is your child allowed to be given food or drink while in our care? (Parent's Night Out includes Cheese Pizza, Snack, and a Juice)*
No
Yes
Alternate Parent/Guardian
Full Name *
Phone Number *
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
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!