Complete a waiver for myself
Complete a waiver for myself and children

Adult Information

(  Indicates a required field )

( Age must be at least 18 years old )

Contact Information

    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.

KATY PLAY GYM, LLC

LITTLE LAND PLAY GYM WAIVER OF LIABILITY

 

In consideration of being allowed to enter and/or participate in any activities at Katy Play Gym LLC dba Little Land Play Gym Katy (Activities), the undersigned acknowledges, appreciates and agrees to the following:

 

1. ACKNOWLEDGEMENTS: 

 

A. Playground and other equipment can be dangerous and can result in serious injury to me and/or my child/children ("Participant"). I understand the nature of the Activities and represent that Participants are qualified, 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. I understand that these Activities may involve risk of serious bodily injury, which may be caused by personal actions/inaction or actions/inaction 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 losses resulting from participation in these Activities;

 

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 Katy Play Gym, LLC activities, such risks including but 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 Participant which could result in personal injury and/or property damage; 

 

C. I also assume all responsibility for supervising and monitoring my child/children while at Katy Play Gym, LLC.

 

2. RELEASE, WAIVER, INDEMNIFICATOIN, HOLD HARMLESS, AGREEMEMENT NOT TO SUE, AND ASSUMPTION OF RISK

 

A. I hereby completely and forever release, waive, indemnify, hold harmless, and agree not to sue Katy Play Gym, LLC, its respective owners, heirs, shareholders, administrators, directors, agents, officers, lessors, volunteers, employees, other participants, any sponsors, and advertisers (Releasees) for any and all liability, 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 others, whether caused by Katy Play Gym, LLC's negligence or otherwise arising out of or in any way related to the Activity;

 

B. I will indemnify, save and hold harmless each of the Releasees from any claim, demands, causes of action, judgments and costs, attorney’s fees, loss, liability, damage, or other cost which relates to, or arises from, this Waiver, to the fullest extent permitted by law. 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;

 

C. I also understand and agree that my execution of this Waiver for myself or my child/children, will authorize Katy Play Gym, LLC to enter this Waiver into its database and use it as a continuous, multi-use waiver for my child's/children’s ongoing participation in the Activities or use it as a Waiver executed for my other child/children. I hereby expressly authorize Katy Play Gym, LLC dba Little Land Play Gym Katy 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, we grant Katy Play Gym, LLC the absolute, perpetual, and irrevocable right to use, in its sole discretion, Our name, face, picture, likeness, voice, appearance image, testimonial statement, and/or other depiction in any reasonable advertising, promotional, trade piece, or media approved by Katy Play Gym, LLC.

 

B. We completely and forever release Katy Play Gym, LLC for any and all liability, claims, demands, actions, causes of action, or suits in equity, of whatsoever kind or nature, whether caused by Katy Play Gym, 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 Minors parent and/or legal guardian, understand the nature of the above referenced Activities and the Minors experience and capabilities and believe that Minor 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 Minors 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 the Participant is covered by his/her own medical insurance and that I have read and understand this document prior to signing it, and that I am aware that by signing this document I am waiving certain legal rights that the Participant or I may have. Should either the Participant or I have any physical limitation or condition that creates the potential for a higher risk of injury while enjoying the Katy Play Gym, LLC facility, I agree to inform Katy Play Gym, 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 Katy Play Gym, LLC to authorize emergency medical treatment as may be deemed necessary for the Minor named below while participating in Katy Play Gym, LLC's Activities. The undersigned hereby releases, discharges, covenant not to sue and agrees to indemnify and save and hold harmless Katy Play Gym, 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 Katy Play Gym, LLC from any litigation expenses, attorney’s fees, loss liability, damages, or costs incurred by Katy Play Gym, LLC as a result of any such claim.

 

I HAVE READ THE ABOVE MEDICAL PERMISSION AUTHORIZATION AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE KATY PLAY GYM, LLC FROM ALL LIABILITY ARRISING 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.

By signing this waiver, I agree that all information is complete and accurate.