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Playhouse Cafe Waiver

I agree for myself and/or the minor(s) listed below that I shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions and conditions for play and participation in any party and/or program at Playhouse Café LLC and agree to pay for all damages to the facilities caused by myself or the listed minors’ negligent, reckless or willful actions. 

I recognize and understand that there are certain inherent risks associated with the use of the play area and that the risks include, without limitation: scrapes, bruises, cuts or more serious injuries.

I fully accept and agree to assume all of these risks (including risks arising from the negligence of other participants) and I assume full responsibility for personal injury to myself and/or listed minor(s). 

I agree to bring any unsafe or negligent behavior to the attention of Playhouse Café staff immediately. 

I hereby waive Playhouse Café LLC, its officers, members, agents, employees and other participants and sponsoring entities for injury, loss or damage arising out of or related to participation in any and all Playhouse Café activities, parties, programs and/or use of any of the facilities at Playhouse Café LLC. 

This waiver and release shall be binding and apply to all risks, known and unknown. 

Each participant must sign this waiver form.

Refusal to sign the waiver restricts guest from participating in any activities inside the playroom. 

We have the right to remove anyone whose presence is inhibiting the experience of other patrons.

I understand that I, not any Playhouse Café staff member, am responsible for supervising the child/children that are attending with me on this day.

I have read and understood everything stated in the above mentioned waiver


May 19, 2024




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 Email Address

Email*

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

First Name*

Last Name*

Emergency Contact's Phone Number*
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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