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I, the undersigned parent or legal guardian, understand and acknowledge that participation in play activities at The Magnolia Play Cafe (hereinafter referred to as "The Cafe") involves inherent risks, including but not limited to, physical injury, property damage, or other consequences. I understand that these risks are a natural part of physical play and cannot be eliminated without compromising the essential qualities of the activity.

I hereby assume all risks associated with my child’s participation in the activities at The Cafe, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my child's participation.

In consideration of The Cafe allowing my child to participate in its activities, I, on behalf of myself, my child, and our respective heirs, administrators, executors, and successors, hereby voluntarily release, waive, discharge, and hold harmless The Magnolia Play Cafe, its owners, officers, directors, employees, volunteers, and agents from any and all claims, demands, or causes of action, including but not limited to, claims of negligence, for any injuries or damages of any kind arising out of or in connection with my child's participation in the activities at The Cafe.

In the event of an emergency, I hereby authorize The Cafe staff to administer basic first aid to my child and/or to contact emergency medical services if necessary. I agree to be responsible for any medical expenses incurred as a result of my child's participation in the activities at The Cafe.

I grant The Cafe the right to take photographs and video recordings of my child during participation in its activities for promotional and marketing purposes. I understand that these images may be used in various media formats, including but not limited to social media, websites, brochures, and other promotional materials.

I understand that The Cafe strives to provide a safe and enjoyable environment for all participants. I agree to ensure that my child will follow the rules and guidelines set forth by The Cafe staff. I acknowledge that The Cafe reserves the right to remove any participant who fails to comply with these rules or who poses a risk to others.

have read and fully understand this waiver and release of liability, and I voluntarily agree to its terms. I acknowledge that by signing this document, I am giving up substantial rights, including the right to sue. I affirm that I am the parent or legal guardian of the participant named above and that I have the authority to sign this agreement on their behalf.

This waiver ensures that participants and their guardians understand the risks involved, release The Magnolia Play Cafe from liability, and provide necessary medical authorization and contact information.

Today's date: December 21, 2024

First Participant’s Name

First Name*

Last Name*
First Participant’s Date of Birth*
First Participant’s Signature*
Second Participant’s Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant’s Date of Birth*
Participant’s 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 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*

Last Name*

Relationship*

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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