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THIS ACTIVITY WAIVER FORM (this "Waiver") dated today, as signed below.

IN CONSIDERATION of being allowed to participate in play, activities, birthdays, and other special events at Berry Patch Playhouse Indoor Playground and other good and valuable consideration, the receipt of which is hereby acknowledged, I, (the “Legal Guardian”) of my child (the “Participant”) agree on his/her behalf with Berry Patch Playhouse, LLC of 3715 E Colorado Blvd, Pasadena, CA 91107, USA (the "Activity Provider") to the following:

DETAILS OF ACTIVITY

1. The Participant will be participating in the use of the facility at Berry Patch Playhouse LLC for indoor play or special events including but not limited to birthday parties (the "Activity") provided by the Activity Provider.

CONSIDERATION

2. Being the lawful guardian of the Participant, and in consideration of the Participant being permitted to participate in the Activity, on behalf of the Participant the Legal Guardian releases and forever discharges the Activity Provider, its owners, directors, officers, employees, agents, assigns, legal representatives, and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims, and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant's participation in the Activity, and not withstanding that such damage, loss, or injury may have been caused solely or partly by the negligence of the Activity Provider.

3. The Legal Guardian understands that the Participant would not be permitted to participate in the Activity unless the Legal Guardian signed this Waiver. 

PARENTAL SUPERVISION 

4.All children must be supervised by a parent or legal guardian at all times while on the premises. The facility does not assume responsibility for supervising children

DAMAGE CLAUSE

5. Parents and/or legal guardians shall be held financially responsible for any damage to equipment, fixtures, or property caused by their child(ren), whether due to negligence, misuse, or failure to follow posted rules and staff instructions.

NEGLIGENCE 

6. In the event a parent or guardian fails to provide adequate supervision, resulting in damage to facility property, they agree to indemnify and hold harmless Berry Patch Playhouse LLC its owners, staff, and affiliates, from any resulting loss, repair costs, or associated expenses. This includes, but is not limited to, costs for repair, replacement, or cleaning of damaged property.

By signing this waiver, I acknowledge that I am responsible for my child(ren)’s actions and will exercise reasonable care in supervising them at all times.

7. The Legal Guardian has the right to inspect the playground equipment before or during a visit and either choose not to participate at the facility or inform the Activity Provider of any concerns. The Activity Provider will aim to keep an up-to-date maintenance and inspection log for the play equipment available for public viewing upon request.

CONCURRENT RELEASE

8. The Legal Guardian acknowledges that this Waiver is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant by the Activity Provider, and with the intention of binding the Participant's heirs, executors, administrators, legal representatives, and assigns.

FITNESS TO PARTICIPATE

9. The Legal Guardian acknowledges to the Activity Provider that the Participant does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent the Participant from participating in the Activity. With that being said, the Activity Provider is an inclusive playground.

Berry Patch Playhouse LLC welcomes children with disabilities, special needs, and neurodiversity and encourages legal guardians and caretakers to assist them as need be with indoor play. If required, the Participant will obtain a medical examination and clearance.

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

10. I understand and acknowledge that participation in activities at Berry Patch Playhouse LLC involves inherent risks, including but not limited to physical injury, bumps, bruises, sprains, broken bones, and other serious injuries that may result from normal play, equipment use, or interaction with other participants.

By signing this waiver, I voluntarily assume full responsibility for any risk of injury, harm, or loss that may occur to my child(ren) while on the premises of Berry Patch Playhouse LLC whether such injury arises from the use of play equipment, participation in activities, or otherwise.

I, on behalf of myself and my child(ren), hereby release, waive, discharge, and hold harmless Berry Patch Playhouse LLC, its owners, employees, agents, and affiliates from any and all claims, liabilities, demands, actions, or causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child(ren) while on the premises or participating in any activities, regardless of whether such loss is caused by negligence (other than gross negligence or willful misconduct) or otherwise.

I further acknowledge and agree that it is my sole responsibility to supervise my child(ren) at all times and to ensure they follow all safety rules and guidelines provided by Berry Patch Playhouse LLC and its staff.

CODE OF CONDUCT FOR PARENTS AND CHILDREN 

In order to ensure a safe, respectful, and enjoyable environment for all guests, we require all parents/guardians and children to adhere to the following Code of Conduct while on the premises of [Business Name]. By signing this waiver, you acknowledge and agree to the following rules:

Children Must:

  • Play safely and respectfully with others at all times.
  • Follow all posted rules and staff instructions.
  • Use equipment as intended and not engage in roughhousing, climbing on non-play areas, or unsafe behavior.
  • Refrain from hitting, pushing, or using inappropriate language.
  • Remain under the direct supervision of a parent or guardian at all times.


Parents/Guardians Must:

  • Actively supervise their children at all times while in the facility.
  • Ensure their child(ren) are following all safety rules and behaving appropriately.
  • Follow all facility rules and respect the instructions of staff members.
  • Address and correct inappropriate behavior or unsafe actions by their child(ren).
  • Be respectful to other guests and staff. Aggressive or abusive behavior will not be tolerated.

VIOLATION OF CODE OF CONDUCT:

Failure to follow this Code of Conduct may result in removal from the facility without refund, and in cases of repeated or serious violations, a ban from future entry. Any damages caused by misconduct or failure to supervise may result in financial liability.

FULL AND FINAL SETTLEMENT

12. The Legal Guardian acknowledges and agrees with the Activity Provider that: (1) the Activity Provider has given the Legal Guardian sufficient time to carefully read this Waiver, (2) the Legal Guardian has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this Waiver, (3) the Legal Guardian fully understands the risks and claims that the Participant is waiving to participate in the Activity, (4) the Legal Guardian is freely and voluntarily executing this Waiver, and (5) the Participant is forever prevented from suing or otherwise claiming against the Activity Provider for any property loss or personal injury that the Participant may sustain while participating in or preparing for the Activity.

GOVERNING LAW

13.This Waiver will be governed by and construed in accordance with the laws of the State of California.

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
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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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*
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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