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WAIVERANDUSEAGREEMENT
In consideration of being allowed to enter the Children’s Movement Center’s (CMC) activity areas, classrooms
and/or exercise rooms, or participate in any party/program or any other event, the undersigned on his or her
behalfand/orbehalfoftheparticipant(s)identifiedbelow,acknowledges,understands,appreciatesandagreesto
thefollowingtermsandconditions:
1.Iunderstandindoorplayequipmentcanbedangerous.TheactivitiesatCMCrequirecertaindegreesofskill,
abilityandphysicalcondition.Iunderstandthattheseactivitiescanresultininjurytotheparticipantsand/orme.
Iassumeanyandallriskofdamageorinjurytomeortheparticipant(s)whileonthepremisesofTheChildren’s
MovementCenter.Inaddition,ifI/weobserveanyhazard/dangerduringourparticipation,Iwillbringittothe
attentionofthenearestCMCemployeeorofficialimmediately.
2. I understand that potentially severe injuries, including, without limitation, permanent paralysis or death can
occurinanyactivityinvolvingheightormotion,includingallofthoseactivitiesofferedwithin,byandthroughthe
CMC.Iacknowledge,understandandagreethatthetermsofthisWaiverapplytoallactivities.
3. I, for myself and the participants named below, and our respective heirs, assigns, administrators, personal
representativesandnextofkin,herebyholdfree,harmlessandindemnifiedandreleaseandforeverdischargeits
officers, members, agents, employees, directors, trustees, affiliates, other participants and all other persons and
entities acting on their behalf, from any and all claims, actions, damages, injuries, liabilities, cost of expenses,
includingattorneyfees,whicharerelatedtoorariseoutofmyselfortheparticipant(s)namedbelowparticipation
oruseofthefacility;andthatIforeverwaivetherighttosueorexerciseanylegalactionsagainstTheChildren’s
MovementCenteronaccountofanyinjuryorloss.
4.Byexecutionofthisagreement,itismyintentiontoassumeallriskofinjuryanddoherebysurrenderandwaive
anyrighttomakeclaim,sueorpursueanylegalrighttoseekdamagesagainstTheChildren’sMovementCenter,its
owners,officers,members,agents,employees,directors,trustees,affiliatesorotherpersonsorentitiesactingon
theirbehalf,fordamagesarisingoutoftheuseoforpresenceontheCMCfacility.
5. I acknowledge that my and the participant’s(s’) named below, participation in activities at The Children’s
MovementCenterisstrictlyvoluntary.IherebycertifythatIamover18yearsofageandvoluntarilyagreetoall
terms,conditionsandresponsibilitiessetforthintheabovetermsandconditionsformyselfandmyparticipant(s),
ourheirsandassignsforever.Iacknowledgethatparticipationhasnotoccurredpriortosigningthisagreement,
and that I fully understand that I assume all risk and waive and release all substantive rights that I and/or my
participant(s)mayhaveandpossess.
Bysigningthisform,Iagreenotonlytothetermsofthewaiverlistedabove,butalsotoabidebythesafetyrules
setforthbelow,andtoensurethatallminorchildrenlistedonthiswaiverformadheretotherulesthatfollow,as
wellasthosewrittenateachpieceofapparatus/equipmentlocatedwithintheCMC.
IunderstandandherebygivetheCMCandanyCMCAssignsmypermissiontolicenseimagesandtouse
imagesobtainedduringparticipationinanyCMCrelatedactivityinanyMedia(includingdigital,electronic,print,
television, film and other media not known or to be invented) and for any lawful purpose which may include
amongothers,advertising,promotion,marketingandpackagingforanyproductorservice.Iagreethattheimages
may be combined with other images, text and graphics, and cropped, altered or modified I agree that I have no
rightstotheImages,andallrightstotheImagesbelongtotheCMCandAssigns.IacknowledgethatIagreeand
thatIhavenofurtherrighttoConsiderationoraccounting,andthatIwillmakenofurtherclaimforanyreasonto
theCMCand/orAssigns.Iacknowledgeandagreethatthisreleaseisbindinguponmyheirsandassigns.Iagree
thatthisreleaseisirrevocable,worldwideandperpetual.
SAFETYRULES:TheChildren’sMovementCenter(CMC)RulesforParentsandParticipants:
TheCMCisdedicatedtoprovidingasafeandfunenvironmentforchildrentoplayandsocializewiththeirfriends.
To maintain our safe environment, each attraction has specific rules that are posted at the entrance. Anyone
unabletoobservetheruleswillbeaskedtodiscontinueparticipationandnorefundwillbegiven.Inaddition,the
followinggeneralruleshavebeenestablishedandmustbefollowedatalltimes.
1.NOFOODORDRINKSareallowedinanyoftheactivityareas.Vendingmachinesarelocatedinthelobbyarea
andfoodanddrinkmustremaininthelobbyaswell.
2.ATTIRE:Looseclothingandjewelrymustberemovedbeforeparticipating,pocketsemptied.
3.Norunning,pushingorroughplayisallowedwithintheCMC.
4.PARENTSMUSTSTAYONTHEPREMISES–Exceptinthoseinstanceswhenexpresspermissiontoleaveachild
on site is documented (i.e., Preschool and Afterschool programs, birthday parties) parents are responsible to
supervisetheirownchildren/andthoseaccompanyingthemtotheCMCthroughoutthetimetheyareonsite.CMC
employeespatroltheactivitycenterconstantlytoassistandhelpsupervise;however,theyDONOTREPLACEthe
needforparentalsupervision.
5.Parent/ortheadultsignatorydesignatedonthisformasresponsibleforeachchildduringagivenvisitaccepts
responsibilitytoseethatthechildrenthattheyaccompanyusetheequipmentsafelyandonlyinthemannerfor
whichitisintended.
NOTEREGARDINGFOOTWARE:Someattractionsrequirethatshoesareon.Someattractionsrequireshoesoff.
Pleaseobservethefollowing:
ShoesOFF:bouncyhouses,trampolines,inflatabletrain,inflatableobstaclecourse,ballpit.
ShoesON:Zipline(closedtoeshoesONLY),climbingwall(recommended),XerPlayroom
Thesurferrequiresbarefeet–shoesandsocksOFF.
Thisisamulti-pageform–youmustinitialthetopofeachandcompleteeachpageentirely.
ParticipantName___________________________DateofBirth___________________
ParticipantName___________________________DateofBirth___________________
ParticipantName___________________________DateofBirth___________________
ParticipantName___________________________DateofBirth___________________
ParticipantName___________________________DateofBirth___________________
I fully understand, appreciate and agree to the foregoing terms and conditions and that I am the
responsible adult for the children I accompany at CMC. Should any term provision or part of this Waiver
andUseAgreementbejudiciallydeterminedtobeunenforceable,thebalanceandunaffectedtermsshall
remaininfullforceandeffect.
Parent/GuardianName:(PLEASEPRINT)________________________________
Parent/GuardianSignature:___________________________________________
Address:_________________________________________________
City:_______________________________State:________Zip:_____________
OPTIONAL: If you would like to receive notification of special offers, events and/or classes at the CMC, please
provideyouremailaddressinthespacebelow:
EmailAddress:__________________________________________
---------------------------------------ForOfficeUseOnly--------------------------------------------------
_____FrontRoom _____Front&BackRoom
_____AllAccess
_____SingleVisit
Payment
Method:_____Cash
_____5VisitPass
_____InternalCreditCard
_____Mgmt.Comp.
_____ExternalCreditCard
_____Coupon
_____MonthlyPass _____HomeSchool
_____GiftCertificate