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Hello and welcome to Chicky Play Museum!

We're excited to have you join in on the fun, but before you "play", please sign our mandatory waiver. This requirement to sign our waiver applies to all families with children playing.

If you have any questions regarding our waiver, don't hesitate to let staff know or email us at info@chickyplaymuseum.com.

The child or children named below (the “Child”) wants to participate in activities offered by Chicky Play Museum (“Chicky Play Museum”). I understand that my agreement with this Liability Waiver and Release (“Waiver”) is a condition to the Child’s participation.

1.    Assumption of Risk, Indemnification, and Limitation of Liability: I understand that Chicky Play Museum’s activities include, among other things, playing in a sandbox, going up and down a slide, and playing with other children around obstacles and equipment, and I further understand that the activities have inherent risks, such as tripping, falling, collisions, and exposure to viruses, bacteria, and other pathogens, which could result in injury, damage, paralysis, or even death. In addition, I understand that I am solely responsible for safeguarding my and the Child’s personal property at Chicky Play Museum and that there is a risk my or the Child’s personal property will be lost, stolen, or damaged. On behalf of myself and the Child, I voluntarily accept full responsibility for all our injuries, losses, and damages that arise from or relate to my or the Child’s participation in Chicky Play Museum’s activities. 

For myself and, if I am the Child’s parent or legal guardian, for the Child, I hereby hold harmless, release, waive, and discharge, to the fullest extent allowed by applicable law, Chicky Play Museum and its officers, members, managers, agents, and employees from any and all claims, demands, losses, damages, costs, and attorneys’ fees on account of any injury, death, or damage to property, arising out of my or the Child’s participation in Chicky Play Museum’s activities, except, however, the foregoing shall not apply in the case of gross negligence or intentional misconduct by Chicky Play Museum. 

2.    Multi-Use Authorization: This Waiver shall be valid for all future visits; except, however, Chicky Play Museum may require me to sign the same or a different liability waiver and release as a condition to the Child’s future participation in Chicky Play Museum’s activities. 

3.    Requirements. I understand and agree to abide by the following requirements. 

(i)   The Child and I will comply with all of Chicky Play Museum’s rules, as they may be changed by Chicky Play Museum in its sole and absolute discretion.

(ii)  I will immediately notify Chicky Play Museum if I become aware of any hazardous or unsafe conditions.

(iii) I grant Chicky Play Museum permission to take photos, videos, and images of me and the Child and to use them for advertising and promotional purposes without my further review or approval. 

(iv)  The Child and I will not participate in Chicky Play Museum’s activities if either the Child or I have, in the prior 14 days, (a) had a body temperature of 100.4º or higher, or (b) suffered any symptoms of the COVID-19 virus, the flu, or the common cold. 

4.    Authority: I am 18 years of age or older, and I have authority to execute this Waiver. 

5.    Severability: If any provision of this Waiver is invalid or unenforceable, the remaining provisions shall remain in full force and effect. 

I have read this Waiver in its entirety; I understand it; and I agree to be bound by its provisions.

First Parent or Guardian Name

First Name*

Middle Name

Last Name*

Phone*
First Parent or Guardian Age Acknowledgment*
First Parent or Guardian Date of Birth*
I certify that I am 18 years of age or older
First Parent or Guardian Signature*
Second Parent or Guardian Name

First Name*

Middle Name

Last Name*
Second Parent or Guardian Date of Birth*
Third Parent or Guardian Name

First Name*

Middle Name

Last Name*
Third Parent or Guardian Date of Birth*
Fourth Parent or Guardian Name

First Name*

Middle Name

Last Name*
Fourth Parent or Guardian Date of Birth*
Fifth Parent or Guardian Name

First Name*

Middle Name

Last Name*
Fifth Parent or Guardian Date of Birth*
Sixth Parent or Guardian Name

First Name*

Middle Name

Last Name*
Sixth Parent or Guardian Date of Birth*
Seventh Parent or Guardian Name

First Name*

Middle Name

Last Name*
Seventh Parent or Guardian Date of Birth*
Eighth Parent or Guardian Name

First Name*

Middle Name

Last Name*
Eighth Parent or Guardian Date of Birth*
Ninth Parent or Guardian Name

First Name*

Middle Name

Last Name*
Ninth Parent or Guardian Date of Birth*
Tenth Parent or Guardian Name

First Name*

Middle Name

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent or Guardian Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
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 Age Acknowledgment*
Parent or Guardian's 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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