Participant & Family Information
Parent/Guardian Name: ________________________
Phone Number: ________________________
Email Address: ________________________
Child(ren) Name(s) & Age(s):
________________________ (Age: ____)
________________________ (Age: ____)
________________________ (Age: ____)
1. Assumption of Risk & Liability Release
I, the undersigned parent or legal guardian, acknowledge that allowing my child(ren) to participate in activities and utilize the play equipment at Mrs. Moss’ Playroom involves inherent risks. These risks include, but are not limited to, physical injury, illness, or property damage.
On behalf of myself, my children, and our heirs, I knowingly and freely assume all such risks. I hereby release, discharge, and hold harmless Mrs. Moss’ Playroom, its owners, employees, and agents from any and all claims, demands, or causes of action arising out of my child(ren)'s participation in the playroom activities.
2. Playroom Rules & Code of Conduct
To ensure a safe and enjoyable environment, I agree to follow and ensure my child(ren) follow(s) these rules:
Socks Only: Outside shoes are strictly prohibited in the play area. Clean, grippy socks are required for all participants.
Parental Supervision: I understand that adult supervision is required at all times. I am responsible for directly monitoring my child(ren).
Food & Drink: No food, drinks, gum, or candy is permitted inside the designated play zones.
Health Policy: I will not bring my child(ren) to the playroom if they are exhibiting signs of illness (e.g., fever, cough, contagious rashes).
Zero Bullying Policy: Harassment, aggressive behavior, or bullying will not be tolerated and may result in immediate removal from the premises without a refund.
3. Photo & Media Release
I hereby grant Mrs. Moss’ Playroom permission to use, reproduce, and publish photographs or video recordings of my child(ren) taken at the facility for promotional, marketing, and social media purposes.
4. Indemnification
I agree to indemnify and hold harmless Mrs. Moss’ Playroom against any and all claims, suits, or actions of any kind whatsoever for liability, damages, or compensation brought by me or anyone on my behalf, including attorney's fees and any related costs, in connection with any accident, injury, or illness my child(ren) may sustain while on the premises.
By signing below, I acknowledge that I have carefully read this Waiver of Liability, fully understand its terms, and recognize that I am giving up substantial legal rights, including the right to sue [Playroom Name].
Parent/Guardian Signature: ________________________
Date: _______________