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Prineville Play Cafe LLC Waiver of Liability

In consideration of being allowed to enter the play area, use playground equipment, or to participate in any party and or program at Prineville Play Café LLC, on his or her behalf, and on behalf of the minor(s) identified below, acknowledges, appreciates, agrees and is fully aware of the risks and hazards in participating in any of the activities on the premises of Prineville Play Café LLC, and further agrees as follows:

I agree for myself and/or the minor(s) listed below that we shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for play and participation in any party and/or program at Prineville Play Café LLC and agree to pay for all damages to the facilities of Prineville Play Café LLC cause by myself or the listed minor(s). In addition, if I observe any hazard during our participation, I will bring it to the nearest Prineville Play Cafe LLC employee or official immediately. I recognize and understand that there are inherent risks associated with use of the play area, parties, and programs, and I on behalf of myself and the minor(s) named below, knowingly and freely assume all such risk, both known and unknown, including those that might arise out of the negligence of other participants and other third parties: and I, for myself, and the minor(s) listed below, and all of our respective heirs, assigns, administrators, personal representatives, and next of kin, waive, release, and discharge Prineville Play Cafe LLC, its affiliates, officers, members, agents, employees, other participants, and sponsoring agencies for injury, loss, or damage arising out of or related to our participation in any and all Prineville Play Cafe LLC activities, parties, programs, and/or the use of our facilities now and in the future.

Each participant must have a waiver form signed, either by them or if you are under 18 years, then signed by a parent or legal guardian. If a waiver is not signed, the person will not be able to participate in the Prineville Play Cafe LLC play area, programs, or parties.

I represent that I am the parent or legal guardian of the minor(s) named below, or I have obtained permission from the parent or legal guardian of the minor(s) listed below to execute this agreement on their behalf. I hereby give permission to Prineville Play Cafe LLC to make use of photographs and images taken during my activity in advertising and promotion activities. This agreement shall remain in effect until revoked in writing by Prineville Play Café LLC.

January 25, 2025

First Participant's Name

First Name*

Middle Name

Last Name*
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*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Middle Name

Last Name*

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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