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My WonderPlay Consent Form

In Consideration of being allowed to enter the play area and/or participate in any party and/or program at WonderPlay Learning, LLC or My WonderPlay Inc., the undersigned, on his or her behalf, and on the behalf of the participant(s) listed, 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 and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party and/or program at My WonderPlay. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest My WonderPlay employee or official immediately. I understand that I am responsible for my child’s safety and behavior at all times each visit.

I am aware that there are inherent risks associated with participation in My WonderPlay programs, parties and I, on behalf of myself and the minor participant(s) named, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants; and,

I, for myself and the participant(s) named, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, WonderPlay Learning, LLC, and My WonderPlay management, their affiliates, officers, members, agents, employees, other participants, 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 My WonderPlay programs, activities, parties, and the use of the play area.

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
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First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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Photo & Video Release
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant My WonderPlay permission to use my likeness in a photograph or video clip in any and all of its publications, including but not limited to all of My WonderPlay's printed and digital publications. I understand and agree that any photograph or video clip using my likeness will become property of My WonderPlay and will not be returned. I acknowledge that since my participation with My WonderPlay is voluntary, I will receive no financial compensation. I hereby irrevocably authorize My WonderPlay to edit, alter, copy, exhibit, publish or distribute this photo/video clip for purposes of publicizing My WonderPlay's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising out of, or related to, the use of the photograph. I hereby hold harmless and release and forever discharge My WonderPlay from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of the authorization. I am at least 18 years of age and am competent to contract in my own name and the name of any minors submitted in this form. I have read this release and I fully understand the contents, meaning, and impact of this release.*
I agree
I do not agree
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*
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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