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    Liability Waiver

Please read the waiver below and fill out the required fields found in the following form sections. All liability language from the waiver will apply to all household members listed below.

LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC

WAIVER OF CLAIMS, RELEASE OF LIABILITY & PUBLICITY RELEASE

 

As consideration for being allowed to enter the facilities of and/or participate in any activities by (collectively, the “Activities”) Little Land Play Gym & Pediatric Therapy, LLC (the “Center”), the undersigned acknowledges, accepts and agrees to the following terms and conditions: 

1. ACKNOWLEDGEMENTS:  

A. I acknowledge that playground and other equipment can be dangerous and can result in serious injury to me, my child/children and/or any guest accompanying me or my child/children (each a "Participant").  I understand the nature of the Activities and represent that the Participants are  in good health, and in proper physical condition to participate in such Activities.  If I believe any of the Activities are unsafe, I will immediately stop participating and/or stop my child/children from participating and notify the Center. I understand that these Activities may involve risk of serious bodily injury, which may be caused by personal actions/inactions or actions/inactions of other participants. I hereby knowingly and voluntarily assume any and all such risks, including presently unknown or unforeseeable risks, and voluntarily assume all responsibility for injury, losses and damages resulting from participation in these Activities; and, 

B. I am aware that in addition to the usual dangers and risks inherent in children's physical play, therapy rooms and play areas, that there are inherent risks associated with participation in the Center’s  activities, such risks include, but are not limited to, the danger and risk of falling, jumping, landing, height, motion, and negligence of other participants. By signing this waiver, I freely accept and fully assume responsibility for all such dangers and risks, both known and unknown, and recognize the possibility of injury to myself and/or a Participant which could result in personal injury and/or property damage;

C. I also assume all responsibility for supervising and monitoring my Participants while at any facility or activity of Little Land Play Gym & Pediatric Therapy.

2. RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AGREEMENT NOT TO SUE, AND ASSUMPTION OF RISK 

A. I HEREBY COMPLETELY AND FOREVER RELEASE, WAIVE, INDEMNIFY, HOLD HARMLESS, AND AGREE NOT TO SUE LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC, ITS RESPECTIVE OWNERS, MANAGERS, SHAREHOLDERS, ADMINISTRATORS, DIRECTORS, OFFICERS, LESSORS, STAFF, VOLUNTEERS, EMPLOYEES, OTHER AGENTS, ANY SPONSORS, AND ADVERTISERS (COLLECTIVELY, THE “RELEASEES”) FOR ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, OR SUITS IN EQUITY, OF WHATSOEVER KIND OR NATURE, FOR HARM, LOSS, DAMAGE, PROPERTY DAMAGE, LOST PROPERTY, STOLEN PROPERTY, PERSONAL INJURY, OR DEATH TO ME OR MY PARTICIPANTS, WHETHER CAUSED BY RELEASEES’ NEGLIGENCE OR OTHERWISE ARISING OUT OF OR IN ANY WAY RELATED TO THE ACTIVITIES; AND 

B. I ALSO HEREBY INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY CLAIMS, DEMANDS, CAUSES OF ACTION, JUDGMENTS AND COSTS, ATTORNEY’S FEES, LOSSES, LIABILITIES, DAMAGES, OR OTHER COSTS WHICH RELATES TO, OR ARISES FROM, THIS WAIVER, TO THE FULLEST EXTENT PERMITTED BY LAW; AND

C.  I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT; AND 

D. I ALSO UNDERSTAND AND AGREE THAT MY EXECUTION OF THIS WAIVER FOR MYSELF OR MY PARTICIPANTS, WILL AUTHORIZE LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC TO ENTER THIS WAIVER INTO ITS DATABASE AND USE IT AS A CONTINUOUS, MULTI-USE WAIVER FOR ME AND MY PARTICIPANT’S ONGOING PARTICIPATION IN THE ACTIVITIES. I HEREBY EXPRESSLY AUTHORIZE LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC TO USE THIS WAIVER AS A MULTI-USE WAIVER UNTIL SUCH TIME AS I REVOKE IT IN WRITING.

3. PUBLICITY RIGHTS

A. Without compensation, residual obligations, obligation, or further approval, I, on my own behalf and on behalf of my Participants, hereby grant Little Land Play Gym & Pediatric Therapy, LLC the absolute, perpetual, and irrevocable right to use, in its sole discretion, the name, face, picture, likeness, voice, appearance image, testimonial statement, and/or other depiction of me and my Participants in any reasonable advertising, promotional, trade piece, or media approved by Little Land Play Gym & Pediatric Therapy, LLC.

B. I completely and forever release Little Land Play Gym & Pediatric Therapy, LLC for any and all liability, claims, demands, actions, causes of action, or suits in equity, of whatsoever kind or nature, whether caused by Little Land Play Gym & Pediatric Therapy, LLC's negligence or otherwise, arising out of or in any way related to such grant and right of use.

4. PARENTAL/LEGAL GUARDIAN CONSENT

A. I, the undersigned parent and/or legal guardian of the Participants who are minors (the “Minors”), understand the nature of the above referenced Activities and the Minors’ experiences and capabilities and believe the Minors to be qualified to participate in such Activities. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES OR DAMAGES ON THE MINORS’ ACCOUNT CAUSED OR ALLEGED TO HAVE BEEN CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE ABOVE RELEASEES, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY’S FEES, LOSS LIABILITY, DAMAGES, OR COSTS ANY RELEASEE MAY INCUR AS A RESULT OF ANY SUCH CLAIM.

5. MEDICAL PERMISSION AUTHORIZATION

A. I HEREBY CERTIFY THAT each Participant is covered by his/her own medical insurance and that I have read and understand this Release prior to signing it, and that I am aware that by signing this Release I am waiving certain legal rights that the Participants or I may have. Should either the Participants or I have any physical limitations or conditions that creates the potential for a higher risk of injury while enjoying the Little Land Play Gym & Pediatric Therapy, LLC facility, I agree to inform Little Land Play Gym & Pediatric Therapy, LLC personnel of such limitation or condition in advance of gaining entry to the facility.

B. If the Participant is of minority age, the undersigned parent or guardian hereby gives permission for Little Land Play Gym & Pediatric Therapy, LLC to authorize emergency medical treatment (and, as applicable, transport) as may be deemed necessary for the Minor named below while participating in Little Land Play Gym & Pediatric Therapy, LLC's Activities. THE UNDERSIGNED HEREBY RELEASES, DISCHARGES, COVENANT NOT TO SUE AND AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES OR DAMAGES ON THE MINORS ACCOUNT CAUSED OR ALLEGED TO HAVE BEEN CAUSED IN WHOLE OR IN PART BY THE NEGLIGENT MEDICAL TREATMENT, FAILURE TO PROVIDE MEDICAL TREATMENT, OR NEGLIGENT RESCUE OPERATIONS, AND FURTHER AGREES TO INDEMNIFY, SAVE AND HOLD HARMLESS LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC FROM ANY LITIGATION EXPENSES, ATTORNEY’S FEES, LOSS LIABILITY, DAMAGES, OR COSTS INCURRED BY LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC AS A RESULT OF ANY SUCH CLAIM.

C. I HAVE READ THE ABOVE MEDICAL PERMISSION AUTHORIZATION AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE LITTLE LAND PLAY GYM & PEDIATRIC THERAPY, LLC FROM ALL LIABILITY ARISING AS THE RESULT OF THIS MEDICAL PERMISSION AUTHORIZATION.

I HAVE READ AND UNDERSTAND THE ABOVE WAIVER OF LIABILITY AND AGREE THAT THIS AGREEMENT APPLIES TO ALL PERSONS, INCLUDING MINORS WHO ARE IN MY CARE, WHO VISIT LITTLE LAND PEDIATRIC THERAPY & PLAY GYM. 

I ACKNOWLEDGE THAT THIS IS A LEGALLY BINDING DOCUMENT.

        Household Information

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