WAIVER OF LIABILITY AND ASSUMPTION OF RISK
(READ CAREFULLY BEFORE SIGNING)
This waiver is good for 1 year.
In consideration of my child (identify he/she below) being allowed to enter premises of Kids N Motion, Inc. KNM being located at
3310 Noble Pond Way #101. Participating in any pf the parties, programs or any other activity on, in and around the Premises,
including but not limited use of play areas, inflatable equipment or any other equipment, structures, areas or spaces on, in and or
around the premises (whether one or more, the “activities”), I agree to this Waiver of Liability and Assumption or Risk (“Waiver”) as
follows:
I represent that: (1) I, ________________, am the parent or legal guardian of __________________, __________________,
_________________,____________________ (“child”), and (2) my Child is in good heath and has no
physical limitations that would affect the safe participation of my Child or others in the activities.
I agree that: (1) my Child and I shall comply with signs and rules that are posted and with any other directions, instructions or rules
that are otherwise communicated, and (2) that I will immediately notify staff members if I observe and hazards or dangers.
I agree, acknowledge and understand that the Activities involve certain risks, and that harm and injuries, including paralysis and
death, can occur. I realize that these risks include, but are not limited to: falls from or contact with walls, equipment, structures or
other improvements; bad decision-making; inattentional contact with others; actions including but not limited to negligent actions of
my Child or other people; misuse of failure of equipment, structures or other improvements; accidents which are not foreseeable. I
acknowledge and understand that this list of risks is not inclusive of all possible risks associated with the Activities and I agree that
said list in no way limits the extent or reach of this Waiver.
On behalf of myself and my Child, I hereby: (1) assume the risks identified above and all other related risks, known and unknown,
which may be encountered in connection with the Activities, specifically including all risk of and for personal injury that may occur
while my Child and /or I are on the premises and /or I are on the Premises and/or participating in the Activities, and (2) waive,
release, hold harmless, and covenant not sue Kids N Motion, Inc and its members, managers, owners, employees, workers,
contractors, affiliates, and agents, for and from any and all claims, demands, suits, actions, losses, damages, penalties or
liabilities of any kind (collectively “Claims”), arising out of , in connection with or related to my Child’s entering into and being on the
Premises, and my Child’s participation in the Activities. This Waiver shall be effective even though said Claims result from the
negligence, wrongful acts, omissions, breach of warranty or strict liability or Kids N Motion, Inc, or the other parties released.
I agree, acknowledge and understand that this Waiver is intended to be as broad and inclusive as permitted by the laws the State
of Virginia and that, if and proportion of the agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue
in full legal force and effect. This Waiver contains the entire agreement between me, Kids N Motion regarding my Child’s entering
on the Premises and my Child’s participation in the Activity, I agree, acknowledge and understand the terms herein are contractual
and not merely recitals and that I have signed this document on behalf of myself and my Child of my own free will.
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS WAIVER BY READING IT BEFORE I SIGNED IT.
Parent/Guardian Signature: ____________________________________________Date_____________________
Parents/Guardian Print Names: _____________________________________________
Participant Name: _____________________________ Participant Date of Birth________/______/______
Participant Name: _____________________________ Participant Date of Birth________/______/______
Participant Name: _____________________________ Participant Date of Birth________/______/______
Address: __________________________________________________City___________________Zip_________
EMERGENCY CONTACT Telephone Number: _________________
E-MAIL: __________________________________________ If you would like to receive email regarding Kids N Motion
How did you hear about Kids N Motion? ____________________
(READ CAREFULLY BEFORE SIGNING)
This waiver is good for 1 year.
In consideration of my child (identify he/she below) being allowed to enter premises of Kids N Motion, Inc. KNM being located at
3310 Noble Pond Way #101. Participating in any pf the parties, programs or any other activity on, in and around the Premises,
including but not limited use of play areas, inflatable equipment or any other equipment, structures, areas or spaces on, in and or
around the premises (whether one or more, the “activities”), I agree to this Waiver of Liability and Assumption or Risk (“Waiver”) as
follows:
I represent that: (1) I, ________________, am the parent or legal guardian of __________________, __________________,
_________________,____________________ (“child”), and (2) my Child is in good heath and has no
physical limitations that would affect the safe participation of my Child or others in the activities.
I agree that: (1) my Child and I shall comply with signs and rules that are posted and with any other directions, instructions or rules
that are otherwise communicated, and (2) that I will immediately notify staff members if I observe and hazards or dangers.
I agree, acknowledge and understand that the Activities involve certain risks, and that harm and injuries, including paralysis and
death, can occur. I realize that these risks include, but are not limited to: falls from or contact with walls, equipment, structures or
other improvements; bad decision-making; inattentional contact with others; actions including but not limited to negligent actions of
my Child or other people; misuse of failure of equipment, structures or other improvements; accidents which are not foreseeable. I
acknowledge and understand that this list of risks is not inclusive of all possible risks associated with the Activities and I agree that
said list in no way limits the extent or reach of this Waiver.
On behalf of myself and my Child, I hereby: (1) assume the risks identified above and all other related risks, known and unknown,
which may be encountered in connection with the Activities, specifically including all risk of and for personal injury that may occur
while my Child and /or I are on the premises and /or I are on the Premises and/or participating in the Activities, and (2) waive,
release, hold harmless, and covenant not sue Kids N Motion, Inc and its members, managers, owners, employees, workers,
contractors, affiliates, and agents, for and from any and all claims, demands, suits, actions, losses, damages, penalties or
liabilities of any kind (collectively “Claims”), arising out of , in connection with or related to my Child’s entering into and being on the
Premises, and my Child’s participation in the Activities. This Waiver shall be effective even though said Claims result from the
negligence, wrongful acts, omissions, breach of warranty or strict liability or Kids N Motion, Inc, or the other parties released.
I agree, acknowledge and understand that this Waiver is intended to be as broad and inclusive as permitted by the laws the State
of Virginia and that, if and proportion of the agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue
in full legal force and effect. This Waiver contains the entire agreement between me, Kids N Motion regarding my Child’s entering
on the Premises and my Child’s participation in the Activity, I agree, acknowledge and understand the terms herein are contractual
and not merely recitals and that I have signed this document on behalf of myself and my Child of my own free will.
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS WAIVER BY READING IT BEFORE I SIGNED IT.
Parent/Guardian Signature: ____________________________________________Date_____________________
Parents/Guardian Print Names: _____________________________________________
Participant Name: _____________________________ Participant Date of Birth________/______/______
Participant Name: _____________________________ Participant Date of Birth________/______/______
Participant Name: _____________________________ Participant Date of Birth________/______/______
Address: __________________________________________________City___________________Zip_________
EMERGENCY CONTACT Telephone Number: _________________
E-MAIL: __________________________________________ If you would like to receive email regarding Kids N Motion
How did you hear about Kids N Motion? ____________________
