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ELY'S PLAY HOUSE WAIVER OF LIABILITY / ASSUMPTION OF RISK I, for myself, my child/children or ward/wards 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 ELY'S PLAY HOUSE. I, for myself, my child/children or ward/wards acknowledge and understand that there are dangers and risks associated with the activities at/by ELY'S PLAY HOUSE and agree to assume all risk of personal injury, including the potential for paralysis and death. I, for myself, my child/children or ward/wards agree to follow the safety instructions provided and acknowledge that failure to do so may result in expulsion from ELY'S PLAY HOUSE. I, for myself, my child/children or ward/wards, and on behalf of my or their heirs, assigns, personal representatives and next of kin, HEREBY HOLD HARMLESS ELY'S PLAY HOUSE, its owners, members, officers, employees, equipment manufacturers and sponsoring agencies from all liability for any such personal injury, disability, death or loss or damage to person or property to the fullest extent of the law. I, for myself, my child/children or ward/wards understand that my execution of this waiver on the initial visit will authorize ELY'S PLAY HOUSE 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 or use it as a waiver executed for my other child/children. I hereby expressly authorize ELY'S PLAY HOUSE to use this Waiver as a multi-use waiver until such time as I revoke it in writing.


NON-SLIPS SOCKS ARE REQUIRED

All individuals entering Ely's Play House on behalf of you and your party will enter with non-skid socks. Ely's Play House provides some for purchase for $3.25 per person, if they do not have socks.


PHOTO RELEASE FORM

Pictures are a great way for us to remember special events, fun and significant moments. With your permission, you agree for Ely's Play House to take photos of the child(s) listed below to use for social media, campaigns and advertisements.


the body of your waiver here.

First Parent/Guardian Name

First Name*

Last Name*

Phone*
First Parent/Guardian Date of Birth*
First Parent/Guardian Signature*
Second Parent/Guardian Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
ADDITIONAL QUESTIONS
We require all non potty trained kids in pull ups or diapers*
GRIP SOCKS are required for playing, do your kids have grip socks on?*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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*

Last Name*

Relationship*

Phone*
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 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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