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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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