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Participation Agreement, Liability Waiver, and Hold Harmless Agreement

A completed waiver by a parent/guardian is required for all minors ("Child") to play or participate in any event or activity at My Little Town, LLC. In consideration of being allowed to enter and/or participate in any activities at My Little Town, LLC, the undersigned acknowledges, understands and agrees to the following:

1.        I am the custodial parent or legal guardian of the child OR I have obtained parental authorization to act on their behalf with respect to the child/children for the purpose of executing this agreement.

2.        I acknowledge that all applicable rules for participation must be followed, and I assume sole responsibility for the supervision and personal safety of the child/children.

3.        I, for myself and for my child/children sign this Waiver and Assumption of Risk in consideration of the opportunity to use the facility, or to participate in any parties or activities at/by My Little Town, LLC.

4.        I, for myself and for my child/children acknowledge and understand that there are dangers and risks associated with the activities at/by My Little Town, LLC and agree to assume all risk of personal injury.

5.        I, for myself and for my child/children agree to follow the safety instructions provided and acknowledge that failure to do so may result in expulsion from My Little Town, LLC.

6.        I, for myself and for my child/children understand that my execution of this waiver on the initial visit will authorize My Little Town, LLC to enter this waiver into its database and use it as a continuous, multi-use waiver for my child’s/children’s ongoing participation in the activities. I hereby expressly authorize My Little Town, LLC to use this Waiver as a multi-use waiver until such time as I revoke it in writing.

MLT has a zero tolerance policy for bullying of any kind and this applies to children and adults. It is the parents responsibility to ensure your child/children are following the playroom expectations.

MLT RESERVES THE RIGHT TO REFUSE SERVICE OR ASK ANYONE TO LEAVE AT ANY TIME, FOR ANY REASON, WITHOUT REFUND.

I HAVE READ THIS FORM THOROUGHLY. I UNDERSTAND THAT, BY SIGNING THIS WAIVER, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS WHICH I, THE CHILD, AND OUR RESPECTIVE HEIRS, ASSIGNS, EXECUTORS, ADMINISTRATORS, PERSONAL REPRESENTATIVES, AND NEXT OF KIN MAY HAVE AGAINST THE RELEASEES, INCLUDING THE RIGHT TO SUE. I SIGN THIS DOCUMENT VOLUNTARILY AND WITHOUT INDUCEMENT.

MEDIA CONSENT FORM AND RELEASE FOR MINOR CHILDREN 

I am the parent/guardian of said minor child. I hereby grant My Little Town, LLC and their agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of My Child, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any My Little Town, LLC publication or on the My Little Town, LLC websites, without payment or any other consideration.  I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless the My Little Town, LLC and their agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release. 

THIS IS A RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING (Both parents, if possible) 

We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the below named child and do hereby give our/my consent without reservation to the foregoing on behalf of My Child. 


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*
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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*
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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