Loading...

Copy and paste the body of your waiver here.

I have voluntarily elected to allow the minor child(ren) identified below and all minor children under my supervision and collectively herein as (“Child” or “Children”), to use the The Nest Play Cafe (the “Facility”). In consideration for being allowed to use said facilities and equipment, and any other services provided by the Facility or its employees or agents at said location or any other location within the State of Delaware, I – on behalf of myself, my Child, or any other person under my supervision or control – represent, acknowledge, and agree as follows:

GENERAL RELEASE

I acknowledge and agree that this Agreement (the “Agreement covers and is intended to release and provide other benefits, contracting COVID-19 (Coronavirus) legal protections, and consideration to the Facility, and their respective and collective agents, owners, officers, managers, shareholders, affiliates, assigns, volunteers, participants, employees, and all other persons or entities acting in any capacity on their respective or collective behalf (collectively, the “Company”). I acknowledge and agree that the terms and conditions in this Agreement shall apply to adult and minor participants and/or observers alike.

DESCRIPTION OF ACTIVITIES, RISKS, AND POTENTIAL FOR INJURY

I acknowledge and agree that I am executing this Agreement as consideration for my Child, myself, and any other person under my supervision and control to use the Facility and participate in related activities. The use of the playground area and equipment at the Facility, and participating in other related activities, is inherently and obviously dangerous. These risks include serious physical and emotional injury, contracting COVID-19, including but not limited to scrapes, cuts, bruises, sprains, fractures, pinches, concussion, death, damager to myself, the Child, and/or third parties, and damage to personal property of any or all such persons. I understand that the risk of injury extends to all extremities and all other parts of the body. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity, which I further agree is for recreational purposes and completely voluntary. I acknowledge and agree that, while the activities that take place at the Facility are monitored generally by Facility employees, it is not feasible for such employees to monitor the activities and actions of all customers at all times or all customers simultaneously. I acknowledge and agree that I am solely responsible for the safety of my Child, myself, and any other person under my supervision and control while in the Facility.

VOLUNTARY ASSUMPTION OF RISK

I acknowledge and agree that I and the Child are participating voluntarily at our own risk. I acknowledge and agree that the actions or activities of other customers or the actions or inactions of the Facility employees could cause me or the Child injury (as described in this Agreement), and that the Company is not responsible for the actions, contracting COVID-19, or activities of other customers using the Facility or the negligence of its employees in supervising the Facility or its usage, including actions, activities, or omissions that result in such harm.

AGREEMENT TO PAY MEDICAL EXPENSES

I acknowledge, accept, and assume the risk of any and all medical conditions, limitations, or disabilities (whether temporary or permanent) that I or the Child possess, whether known or unknown, which might contribute to or exacerbate any injury I or the Child might sustain as a result of using the Facility or any of its equipment. I acknowledge and agree that if medical assistance (of any form, including emergency care, hospitalization, out-patient care, and/or physical therapy) is required or performed as a result of any injury, I or the Child sustains, while using the Facility, such assistance shall be at my own expense.

RELEASE OF LIABILITY

The Releasing Parties (as defined below) hereby forever, irrevocably and unconditionally release, waive, relinquish, discharge from liability and covenant not to sue the Company, and their successors, predecessors-in-interest, and insurers (collectively, the “Releasees”) form any and all claims, demands, rights, actions suits, causes of action, obligations, debts, costs, losses, charges, expenses, attorneys’ fees, damages, judgments and liabilities, contracting COVID-19, of whatever kind or nature, in law, equity or otherwise, whether now known or unknown suspected or unsuspected, and whether or not concealed or hidden, related to or arising, directly or indirectly, from my or the Child’s access to and/or use of the Facility, premises and/or its equipment, the Child’s and/or my entry in to the Facility, the condition, maintenance, inspection, supervision, control or security of the Facility, the failure to warn of dangerous conditions in connection with the Facility, and/or acts or omissions of the Company or any of the Releasees, including, without limitation, any claim alleging negligent act(s) or omission(s) of Releasees. This release extends to claims seeking relief for any and all forms of damage or injury, including property damage, personal injury, emotional injury, illness, bodily harm, paralysis or death. I understand that this release and waiver applies to all activities at the Facility. I understand that this release and waiver applies to and included all activities that I or my Child engage in at the premises, whether inside or outside of the Facility. In the event that any claim released herein is brought by, or asserted on behalf of the Releasing Parties, I shall immediately defend, indemnify and hold harmless the Releasees, and any of them, from any loss or liability, including reasonable attorneys’ fees, associated therewith or arising therefrom.

In the event of a medical emergency and when the parent or guardian of a Child is unavailable, the undersigned hereby authorize(s) any of the staff, employees, agents and representatives of the Company to provide for, approve and authorize any health care at any hospital, emergency room, doctor’s office or other institutions, employ any physicians, dentists, nurses or other person whose services may be needed for such health care, review and if necessary disclose the contents of any medical records, execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical, or dental care to the Child. Health care shall include, but not be limited to the administration of anesthesia, x-ray, examination, performance of operations, diagnostic and other procedures.

RELEASE OF PHOTO, VIDEO, SOCIAL MEDIA

I hereby grant the Facility on behalf of myself and the Child the irrevocable right and permission to photograph and/or record me or the Child in connection with the activities and the Facility and to use the resulting photographic images, audio or video for all purposes, including social media and promotional purposes, in any matter and in any media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration, and without any reimbursement of any kind due to me or the Child. On my behalf and on behalf of the Child, I waive any right to inspect or approve the use of any such photographic image, audio or video. I agree that the Facility will be the exclusive owner of all rights, including but not limited to the copyrights, in and to the photographic images, audio and video and the results and proceeds of my participation hereunder.

CERTIFICATIONS

In order to assist the Facility in effectively providing for the safety of me and the Child, I certify that:

• I agree that I will not leave the Facility or any other premises of the Company without my Child, or any other person under my supervision and control.

• I have no knowledge of any health problems that would cause participation in the activities to negatively impact my health of the health of the Child;

• I and the Child possess a sufficient level of physical fitness and skill to safely participate in the activities, and neither I nor the Child have any pre-existing physical or medical conditions that might be impacted or worsened by use of the Facility;

• I will not use or allow the Child to use the Facility while any of us are under the use of any substance or medications that may impair our physical activities or judgment;

• I agree to follow (and cause the Child to follow) all safety rules of the Facility and to alert the Facility staff to any rules violations or dangerous behavior of other participants;

• I understand that my failure or refusal to abide by the safety rules of the Facility or by instructions and directions of Facility staff can lead to the immediate revocation of my right to use the Facility, without any right to refund of any payments made;

• I will notify Facility staff before I or the Child participate in activities if any of us have been diagnosed with behavior disorders or are taking any behavior modification medications;

• I will inform Facility staff immediately if I or the Child feel any unusual discomfort while participating in the activities and will immediately stop (or cause the Child to stop) participation in the activities;

• I am aware that Facility staff may need to end my or the Child’s participation in the activities if my or the Child’s actions present a danger to myself or others;

• I acknowledge that the Facility encourages each participant to obtain medical clearance prior to participating in the activities;

• I have adequate insurance to cover any injury or damage I and the Child may cause or suffer while participating in the activities, or if not, I agree to bear the costs of such injury or damage to myself, the Child, and others.

TERM OF AGREEMENT

I understand that this agreement shall continue in effect and will be in full force and legal effect each time I or the Child visit the Facility, whether at the current location or any other location or Facility. I agree that the Facility may require me to sign a new agreement at any time as a requirement for my participation or the participation of the Child in the activities.

ATTORNEY’S FEES

I promise to indemnify the Facility for any attorney’s fees and costs incurred by the Facility to enforce this agreement including costs associated with any collection efforts. If the Facility obtains a judgment against me pursuant to this agreement, prejudgment and post- judgment interest shall accrue thereon at the maximum amount allowed by applicable law.

GOVERNING LAW; VENUE; DISPUTE RESOLUTION

This agreement shall be governed by and interpreted in accordance with the laws of the state in which the Facility is located (“Pennsylvania”) without regard to the conflict of law rules Pennsylvania. I agree and acknowledge that any claim or dispute arising or related to this agreement or the relationship of the parties in any respect thereto shall first be submitted to mediation, and that engaging in such mediation is a condition precedent to bringing any claim against the Facility arising from or related to this agreement. Such mediation may be initiated by either party by providing a written demand for mediation to the other party and shall be conducted within Pennsylvania in accordance with the then current Commercial Mediation Procedures of the American Arbitration Association (“AAA”). If settlement is not reached within sixty (60) days after delivery of a written demand for mediation, such claim or dispute shall be submitted to and be settled by final and binding arbitration in Pennsylvania in accordance with the then current Commercial Arbitration Rules of the American Arbitration Association. If arbitration is not available, or in the event of litigation to enforce arbitration or settlement between the parties to this agreement, I agree that sole jurisdiction and venue shall be in the state and federal courts located in Pennsylvania, and I waive any defense of jurisdiction and/or venue that may now or hereafter exist.

ENTIRE AGREEMENT; SEVERABILITY

I understand that this is the entire agreement between the undersigned and the Facility, and that it cannot be modified or changed in any way by the representations or statements of the Facility or its employees or agents or by the undersigned. This agreement supersedes all previous oral or written promises or agreements. I understand and agree that this agreement is intended to be as broad and inclusive as permitted by the laws of Pennsylvania and that if any portion thereof is held invalid, it is agreed that the remainder of the agreement will remain in effect and will continue in full legal force and effect.

EFFECT OF AGREEMENT

I have read the above and fully understand the terms of this agreement and I have either consulted an attorney regarding the agreement or have elected not to do so. I am aware that by signing this agreement, I am giving up rights that I may have to be bring a legal action or assert a claim against the Company on the basis of their negligent acts or omissions. I understand that by signing this agreement I may be found by a court of law to have forever waived my rights and the rights of the Releasing Parties and the Child to maintain any action against the Company on the basis of any claim from which I have released the Company. I am giving up these important legal rights voluntarily, freely, under no threat of duress, without inducement, promise or guarantee being communicated to me. I have had reasonable and sufficient opportunity to read and understand this entire agreement. I unconditionally agree to the full terms, statements, warranties, notices, representations, waivers and releases contained in this agreement on behalf of myself, the Releasing Parties and the Child listed below. I certify that I am the parent, legal guardian or authorized agent of the Child listed below and that I have the authority to sign this agreement on their behalf. I also certify that the information provided below for each Child participant is true and correct. I acknowledge that the Facility staff may require me to present picture I.D. to verify my identity.

First Caregiver Name

First Name*

Middle Name

Last Name*

Phone*
First Caregiver Date of Birth*
First Caregiver Signature*
Second Caregiver Name

First Name*

Middle Name

Last Name*
Second Caregiver Date of Birth*
Third Caregiver Name

First Name*

Middle Name

Last Name*
Third Caregiver Date of Birth*
Fourth Caregiver Name

First Name*

Middle Name

Last Name*
Fourth Caregiver Date of Birth*
Fifth Caregiver Name

First Name*

Middle Name

Last Name*
Fifth Caregiver Date of Birth*
Sixth Caregiver Name

First Name*

Middle Name

Last Name*
Sixth Caregiver Date of Birth*
Seventh Caregiver Name

First Name*

Middle Name

Last Name*
Seventh Caregiver Date of Birth*
Eighth Caregiver Name

First Name*

Middle Name

Last Name*
Eighth Caregiver Date of Birth*
Ninth Caregiver Name

First Name*

Middle Name

Last Name*
Ninth Caregiver Date of Birth*
Tenth Caregiver Name

First Name*

Middle Name

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

Email*

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