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**Assumption of Risk, Waiver, and Release of Liability**

This Assumption of Risk, Waiver, and Release of Liability applies to all activities at Madeline's Play Café.

**1. Risk Acknowledgment:** I fully understand and acknowledge that engaging in activities at Madeline's Play Café entails inherent risks. These risks include, but are not limited to, bodily harm, permanent disability, paralysis, and even death. Such risks may arise from various circumstances, including equipment misuse, the physical nature of activities, and interactions with other participants.

**2. Assumption of Risk:** By choosing to utilize the facilities at Madeline's Play Café, I do so entirely at my own risk. I understand and accept that participation in activities here may lead to unforeseen injuries, illnesses, or damages to myself, my children, or third parties. I willingly assume all such risks and take full responsibility for any consequences that may arise.

**3. Policies and Procedures Acknowledgment:** I hereby confirm that I have thoroughly reviewed and agree to adhere to all policies and procedures governing the use of Madeline's Play Café facilities. I understand that failure to comply with these rules may result in the termination of my access to the facility.

**4. Release of Liability:** I hereby release, waive, and discharge Madeline's Play Café and its staff from any and all claims, liabilities, or expenses, including but not limited to property damage, personal injury, or death, arising from my use of the facilities.

**5. Waiver:** I knowingly and voluntarily waive any protections provided by statutes or laws intended to limit releases to known claims. I understand and acknowledge that I release unknown future claims as well.

**6. Damages Payment:** I agree to indemnify and hold harmless Madeline's Play Café against any and all claims, demands, liabilities, losses, damages, costs, or expenses, including legal fees, that may arise as a result of my or my family's willful actions, neglect, or recklessness. 

**7. Representatives:** This agreement extends to myself, my heirs, assigns, and legal representatives, binding us all to its terms and conditions.

**8. Insurance:** I acknowledge that I am solely responsible for any medical expenses or other costs incurred as a result of my use of Madeline's Play Café and its facilities. I understand the importance of having adequate health insurance coverage and strongly advise obtaining it before using the facilities.

**9. Arbitration:** All parties agree to attempt mediation in good faith before pursuing arbitration or litigation under [State Name] laws. In the event of arbitration or litigation, the prevailing party shall be entitled to recover costs and reasonable attorney fees.

**10. Photography Release:** I hereby grant Madeline's Play Café permission to use myself or my children in promotional material, including but not limited to photographs, videos, or other digital media, without compensation.

**11. Certification:** I certify that all responses provided to safety and health questions are accurate to the best of my knowledge and belief.

**12. COVID-19 Acknowledgment:** Given the contagious nature of COVID-19, I acknowledge and assume all associated risks. I release Madeline's Play Café from any liability for injuries, illnesses, or damages related to exposure to COVID-19 while using its facilities.

As the parent or legal guardian, I have carefully reviewed and understand the terms of this Assumption of Risk, Waiver, and Release of Liability, and I consent to its terms on behalf of myself and any minor child(ren) under my care.

April 4, 2026

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