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New Waiver

In Consideration of being allowed to enter the play area and/or participate in any party and/or program at Miko’s Playhouse, the undersigned, on his or her behalf, and on the behalf of the participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:


I represent that I am the parent or legal guardian of the participant(s) named above, or I have obtained permission from the parent/legal guardian of the participant(s) named above to execute this agreement on their behalf. I agree that the participant(s) named above and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party and/or program at Miko’s Playhouse. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Miko’s Playhouse employee or official immediately. I understand that I am responsible for my child’s safety and behavior at all times each visit.


I am aware that there are inherent risks associated with participation in Miko’s Playhouse programs, parties and I, on behalf of myself and the participant(s) named on the reverse, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants; and,


I, for myself and the participant(s) named above, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, Miko’s Playhouse, LLC, and Miko’s Playhouse management, their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our participation in any and all Miko’s Playhouse programs, activities, parties, and the use of the play area.









First Participant Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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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