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ERIE PLAY PORT, LLC/PLAY PORT

RELEASE AND WAIVER 



In consideration of being able to participate in various activities at a ERIE PLAY PORT, LLC, the undersigned, on his or her own behalf, and on behalf of any executors, heirs, successors and assigns hereby acknowledges and agrees as follows:

1. The undersigned knowingly and fully assumes all risks, known and unknown, associated with participation in activities at ERIE PLAY PORT, LLC and waives all claims for damage to person or property arising from such participation. This release and waiver covers risks of death, serious injury and property loss whether arising from (i) negligence or carelessness on the part of the persons or entities being released and other participants, or (ii) dangerous or defective equipment.

2. The undersigned certifies that he or she is physically fit and may participate in the activities available at ERIE PLAY PORT, LLC and has not been advised otherwise by a qualified medical person;

3. The undersigned on his or her behalf and on behalf of any executors, heirs, successors and assigns hereby releases, discharges and holds harmless any authorized entity doing business as ERIE PLAY PORT, LLC (the “Company”) and its officers, agents, employees, representatives, and all affiliates, from any and all claims, damages or liability arising from death, disability, personal injury, property damage or theft, or actions of any kind;

4. The undersigned agrees to comply with the rules and conditions of participation expressed or posted at ERIE PLAY PORT, LLC. If the undersigned observes any significant hazard during such participation, the undersigned will promptly inform an employee of ERIE PLAY PORT, LLC; and

5. The undersigned acknowledges that this release and waiver of liability form will be used and relied upon by the Company and that it will govern the undersigned’s actions and rights.

September 22, 2023

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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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:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant

Parent/Guardian Acknowledgment

The undersigned parent and/or guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above of all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act, and releases said parties on behalf of the minor and the parents or legal guardian.

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*
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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