Parents or guardians have sufficient opportunity to read the digital waiver generated by the software for liability kids play the center waiver before signing.

PNO Waiver

BusyKidz Parent’s Night Out 2018

Liability Waiver - Must Be Signed By Legal Guardian

My children are of acceptable behavior, are medically able, and properly trained to be at Parent’s Night Out. My children will abide by all decisions of adult supervision at Parent’s Night Out. I assume all risks associated with Parent’s Night Out, including but not limited to falls, contact with other participants, the effects of the weather, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my form to participate in Parent’s Night Out, I, for myself and anyone entitled to act on my behalf, waive and release BusyKidz Play Town and Interactive Museum (Hereafter referred to as BusyKidz) and its officers and agents, all employees and sponsors, their representatives and successors from all claims or liabilities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I understand that I am financially responsible for any damage done to the facility by my child. I understand I am financially responsible for late pick-ups. $1/minute after five minutes and $50 for every 15 minutes after that.

Consent to Treatment, Photographic Release, and Insurance Disclaimer

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Consent to Emergency Medical and Dental Treatment: As the parent, domestic partner, or authorized representative, I hereby give consent to BusyKidz and its employees to obtain all emergency medical or dental care prescribed by a duly licensed physician (M.D.), Osteopath (D.O.), or Dentist (D.D.S.) for my child (ren). This care may be given under whatever conditions are necessary to preserve the life, limb, or wellbeing of the child named above. *Please click the yellow area and provide your initials here.

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Photographic and Video Release: Throughout the event, there may be activities, events, or media releases that could result in your child being photographed. You agree that BusyKidz may use these photographs in promotions for the program, publish them with local articles, or use them to produce marketing materials. *Please click the yellow area and provide your initials here.

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Insurance Disclaimer: BusyKidz does not carry health or accident insurance on its participants. All expenses incurred in the treatment of illness, injuries, or accidents will be the responsibility of the participant and his/her parents. *Please click the yellow area and provide your initials here.

By signing this document, I acknowledge that if anyone is hurt or property damaged during my participation in this activity, I may be found by a court of law to have waived my or the minor participant’s right to maintain a lawsuit against BUSYKIDZ, LLC. or any RELEASED PARTIES on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. *Please check it here.

Please list any allergies, medications, medical conditions, restrictions or any necessary special accommodations in which the staff should be aware of. Please note that BusyKidz staff is not trained to administer medications/medical equipment of any kind: *Please enter your answer here.

Parent or Guardians First and Last Name: *Please enter your name.

Child(rens) First and Last Name(s): *Please enter your name.

Phone number: *Please enter your phone number.

Please fill in Address: *

Please enter address.

Email: *Please enter your email.

Your signature *

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