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Assumption of Risk:

In consideration of my admission and participation in any party and/or program at Little Village Play, LLC, I acknowledge and willingly agree that:

I, and any minor children I am the parent or guardian of, are entering Little Village Play voluntarily and of our own free will.

I, and any minor children I am the parent or guardian of, acknowledge and fully understand that activities within the facility involves risk of injury.

I am aware that there are inherent risks associated with participation in Little Village Play, LLC programs, parties, and classes, and I, on behalf of myself and any minor children I am the parent or guardian of, 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, assignees, administrators, personal representatives, and next of kin, hereby release and hold harmless, Little Village Play, LLC, and Little Village Play, LLC 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 Little Village Play programs, activities, parties, and the use of the play area.

I agree that I, and any minor children I am the parent or guardian of, 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 Little Village Play, LLC. 

In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Little Village Play, LLC employee immediately. I understand that I am responsible for my child’s safety and behavior at all times each visit.

Video Surveillance:

I understand that to promote the safety of employees and guests, as well as the security of its facilities, Little Village Play, LLC may conduct video surveillance of any portion of its facility at any time, the only exception being private areas such as bathrooms. Video cameras will be positioned in appropriate places within and around the facility to promote safety and security of people and property. 

Drop off:

For drop off birthday parties I understand that it is my responsibility to arrange for the participant(s) to be picked up from Little Village Play on time.

In the event of an emergency, Little Village Play will attempt to contact me. If I cannot be reached, Little Village Play is authorized to contact one of my Emergency Contacts. In the event no Emergency Contact can be reached, Little Village Play is authorized to act for me according to their best judgment in obtaining emergency medical treatment for any participant(s) named. Because some children may be allergic, participants may not bring any peanuts, peanut butter, or other nuts onto the premises. 

By submitting this form, you acknowledge and agree that you are affixing your electronic signature. The parties agree that the electronic signature of a party to this agreement shall be as valid as an original signature. This agreement will apply to participants future participation in activities at Little Village Play, LLC for one year from the date of signature.

Today's Date: May 6, 2024

First Parent's Name

First Name*

Last Name*
First Parent's Age Acknowledgment*
First Parent's Date of Birth*
I certify that I am 18 years of age or older
First Parent's Signature*
Second Parent's Name

First Name*

Last Name*
Second Parent's Date of Birth*
Third Parent's Name

First Name*

Last Name*
Third Parent's Date of Birth*
Fourth Parent's Name

First Name*

Last Name*
Fourth Parent's Date of Birth*
Fifth Parent's Name

First Name*

Last Name*
Fifth Parent's Date of Birth*
Sixth Parent's Name

First Name*

Last Name*
Sixth Parent's Date of Birth*
Seventh Parent's Name

First Name*

Last Name*
Seventh Parent's Date of Birth*
Eighth Parent's Name

First Name*

Last Name*
Eighth Parent's Date of Birth*
Ninth Parent's Name

First Name*

Last Name*
Ninth Parent's Date of Birth*
Tenth Parent's Name

First Name*

Last Name*
Tenth Parent's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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 Age Acknowledgment*
Parent or Guardian's 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.


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