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Play Waiver


In Consideration of being allowed to enter the play area and/or participate in any party and/or program at Itsy Bitsy Play & Cafe, 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 below, or I have obtained permission from the parent/legal guardian of the participant(s) named below to execute this agreement on their behalf. I agree that the participant(s) named below 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 Itsy Bitsy Play & Cafe. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Itsy Bitsy Play & Cafe employee or official immediately. I understand that I am responsible for my child’s safety and behavior at all times each visit. I understand that my child will remain in my clear view at all times during my visit.

I Agree

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

I Agree

I, for myself and the participant(s) named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, Itsy Bitsy Play & Cafe, LLC, and Itsy Bitsy 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 Itsy Bitsy Play & Cafe programs, activities, parties, and the use of the play area. 

I Agree

I, for myself and the participant(s) named above, will read and abide by all posted rules including, but not limited to: wearing socks inside of the play area, ensuring only non-walker/crawling children enter the enclosed baby area, ensuring only children ages 5 and under are playing within the play area, and refraining from throwing or misusing toys in any way. I also understand that there is no food, drink or gum allowed in the play area at any time. I understand that in order to play, my child(ren) must be well and free of any communicable/contagious illnesses. 

I Agree

I understand that I am responsible for the monitoring of the participant(s) named above during the entirety of our visit. 

I Agree

NOTE: We reserve the right to ask any guest who does not adhere to this signed agreement to leave without refund.



Photography/Video/Media Consent
I grant permission to Itsy Bitsy Play & Café, LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Itsy Bitsy Play & Café, LLC and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statement that are given at the facility, with or without my name, for the purpose of advertising and publicly without restriction. I waive my right to any compensation. *
Yes
No
First Participant's Name

First 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*

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 Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*

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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