Loading...

Participation Agreement,

Liability Waiver, and Hold

Harmless Agreement


I, _______________,[print name] and as parent or legal guardian of the child

(or children) whose name is set forth below (each referred to as a “Participant”

and collectively referred to herein as the “Participants”) and in consideration of

the Participants being permitted to participate in the Activities (as defined

below) conducted by Coos Playtopia LLC, located at 2227 Newmark St.,

North Bend, Oregon, 97459 (“Coos Playtopia”) agree as follows:

1. Activities – Activities shall be defined as the various activities and

services offered to Participants by Coos Playtopia, an indoor

playground.

2. I understand that the employees of Coos Playtopia, LLC are not

responsible for Participants who utilize the space and it is the

responsibility of the undersigned individual to supervise any minors they

bring into the facility.

3. I, and the children under my care, understand and agree to the safety

rules and play guidelines as outlined on coosplaytopia.com. I

acknowledge that these rules and guidelines may change and that I

have read and am familiar with them prior to entering the play space

and making use of the facility.

4. COVID-19 WARNING. An inherent risk of exposure to COVID-19 exists

in any public place where people are present. COVID-19 is an

extremely contagious disease that can lead to severe illness and death.

According to the Centers for Disease Control and Prevention, senior

citizens and guests with underlying medical conditions are extremely

vulnerable.

BY VISITING COOS PLAYTOPIA LLC, YOU VOLUNTARILY ASSUME ALL

RISKS RELATED TO COVID-19.


3. ASSUMPTION OF RISK – In addition to the inherent risk of exposure to

COVID-19, I also understand that the Activities entail the risk of severe

bodily injury to the Participants. Injuries that could result may vary, but

may include (a) minor injuries such as scratches, bruises and sprains;

(b) major injuries such as eye injury or loss of sight, joint or back injuries

and concussions; and (c) catastrophic injuries, including paralysis and

even death.

I understand that, Coos Playtopia cannot eliminate all risks or guarantee

the safety of the Participants while Participants participate in the

Activities. I have made my own investigation of these risks, understand

these risks, and assume them knowingly and willingly on behalf of

myself and my minor Participant child. Notwithstanding these risks and

other hazards that may be foreseeable but not specifically identified

herein, I, for myself and any minor Participant child, and our respective

heirs, personal representatives and assigns, understand, acknowledge,

and expressly and voluntarily assume all risks and full responsibility for

any sickness or injury arising out of or related to the Activities.

4. RELEASE, DISCHARGE & AGREEMENT NOT TO SUE – I, for

myself and any minor Participant child and our respective heirs,

personal representatives and assigns, do hereby release,

discharge and agree not to sue Coos Playtopia or its managers,

members, employees and/or other agents, for any sickness, injury

to or death of any Participant arising, directly or indirectly, from

participation in the Activities. This release, discharge and

covenant not to sue shall relate to any and all claims or legal rights

now existing or arising in the future, including claims and legal

rights arising out of any negligence of Coos Playtopia and/or its

managers, members, employees and/or other agents and any other

breach of a legal duty arising out of common law, statute, contract

or otherwise. 

5. Indemnification And Hold Harmless – I hereby agree to indemnify

and hold harmless COOS PLAYTOPIA from and against any and all

losses, liabilities, claims, obligations, costs, damages, and/or expenses

whatsoever paid, incurred, and/or suffered by COOS PLAYTOPIA,

including, but not limited to, and and all attorneys’ fees, costs, damages,


and.or judgments COOS PLATYOPIA incurs in the event that I, my

minor child(ren)/ward(s) or anyone for which I signed this agreement

causes any injury, damage and/or harm to COOS PLAYTOPIA and.or

any and all other persons and entities acting in any capacity on behalf of

COOS PLAYTOPIA or to others while at COOS PLAYTOPIA premises.

6. ATTORNEYS’ FEES. I promise to indemnify and hold harmless COOS

PLAYTOPIA for any attorneys’ fees and/or costs incurred o enforce this

agreement, including all costs associated with any collection efforts.

Further, should any debt and/or judgment accrue in favor of COOS

PLAYTOPIA pre-judgment and post-judgment interest shall accrue

thereon at the legal rate.

7. Security Cameras. I understand that security cameras installed around

and within Coos Playtopia’s facility are for the safety of all participants

and may be referenced should any incidents or injury occur.

8. Photo Release. I grant Coos Playtopia permission to use any

photographs, video, or sound bites obtained of me or any minor

Participant child at Coos Playtopia’s facility for any legal use including

but not limited to: publicity, advertisement and web content. I understand

that no royalty or other compensation shall be payable to me or the

minor Participant by reason of such use.

9. Parent or Legal Guardian Certification and Consent – I hereby

certify that I am the parent or legal guardian of the minor Participant

children whose name(s) appear below, and I have authority to waive

rights on behalf of the minor Participant(s). I have read and I understand

all of the provisions of this document and the risks of the Activities. I

understand that the Activities could cause injury and even death. I

acknowledge that I have read and understand the terms of this

document and I am freely and voluntarily signing this document. This

Participation Agreement, Liability Waiver, and Hold Harmless

Agreement has no expiration date.

10. TERMS OF AGREEMENT. I understand that this agreement

extends forever into the future and will have full force and legal effect


each and every time I or my child(ren)/ward(s) visit COOS PLAYTOPIA

whether at the current location or any other location or facility.

11. VENUE/MEDIATION. In the even a lawsuit is filed against COOS

PLAYTOPIA, I agree to the sole and exclusive venue of the County of

Coos. I further agree that the substantive law of Oregon shall apply

without regard to any conflict of law rules. I also agree that if any portion

of this agreement is found to be void or unenforceable, the remaining

portion shall remain in full force and effect. Prior to any lawsuit I agree to

participate in mediation, in person, with COOS PLAYTOPIA to attempt

to resolve the dispute without litigation.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's 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*

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!