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RELEASE OF LIABILITY FORM

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 provide some for purchase for $3 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. 

Today's Date: May 5, 2024

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:*
First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Additional Questions
Are all grown ups wearing socks, socks are required to be worn by all entering adults for hygiene and State Licensing purposes. *
No
Yes
Are ALL kids wearing NON SLIP SOCKS?*
Kids 8 years of age and under are allowed to play at the facility, are all minors 8 years of age and under?*

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 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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