waiver_form

"Not too big, not too small,
Come in and play... we're just right!"

Waiver Form

PLEASE COMPLETE WAIVER PRIOR TO PAYING

In consideration for participation in activities at Little Bears Indoor Playground, Inc., I hereby
agree on my behalf and on behalf of the minor(s) listed below to the following:

I understand that participation in Little Bears Indoor Playground, Inc. activities is risky and
that risks of injury include without limitation, scrapes, bruises, cuts, and even more serious
injuries, such as paralysis or death, and I fully accept and agree to assume all of these risks
(including risks arising from the negligence of other participants), for myself and all children
listed below. I understand that it is my responsibility to supervise the children listed below
when they are participating in activities at Little Bears Indoor Playground, Inc., not the
responsibility of Little Bears Indoor Playground, Inc., I will obey and will make sure that all
children listed below obey the rules posted at Little Bears Indoor Playground, Inc.. I
understand that violation of rules could result in expulsion from Little Bears Indoor
Playground, Inc. with no monetary reimbursement.

With the full understanding of the risks stated above I, for myself and all the children listed
below, hereby release, hold harmless and forever discharge and covenant not to sue Little
Bears Indoor Playground, Inc., its owners, officers, directors, agents, employees, and all
other persons acting on its behalf, for any injury at or related to Little Bears Indoor
Playground, Inc., and agree to reimburse any reasonable attorney’s fees and costs that may
be incurred by Little Bears Indoor Playground, Inc.

I agree and understand that this agreement is binding on myself, my child and all children
listed below and the heirs, successors and assigns of myself, my child, and all children listed
below. By signing below, I certify that I am the legal parent or guardian of the child(ren) for
whom I am signing or, if I am not the parent or legal guardian, that I have the express
permission of the child(ren)’s legal parent or guardian. I understand that this is a permanent
waiver to kept on file by Little Bears Indoor Playground, Inc. for today’s visit and all future
visits.

Today's Date:_____/______/______

Signed:__________________________________Print Name:_________________________

Address:_________________________________________________________________________

City:__________________________________________ Zip:____________________

Home or Work Phone:________________________Cell Phone: _______________________

Email:___________________________________________________________________________

Child's Name                                                                Birth Date

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