Waiver Form

Please make sure to fill this waiver form before your visit.

First Name

Last Name

I acknowledge that if on the day of the visit, if me or my child has body temperature greater than 100.4 F, if me or my child or any family member have had flu like symptons in the past 14 days, if me or my child has come in close contact with anyone who has had flu like symptons in the past 14 days, or if me and my child travelled out of state to COVID restricted states as per CDC guidelines, we will not be admitted in the facility. My payment will be transferred to a later date.

Are you or the child experiencing or have experienced any flu symptoms in the past 14 days?

Yes

Date

Initials

I certify that I am the parent/caregiver/guardian of the “Visitor” and agree to the following in relationship to the services that Urban Jungle Play (UJP) provides. I also certify that the child/all visitors with me are up to date on all of their shots/immunizations. RELEASE AND WAIVER OF LIABILITY. Visitor recognizes that there are hazards and risks connected with playtime. As such, the Visitor hereby exempts, releases and holds harmless UJP and its officers, agents, employees and volunteers from any and all claims or causes of action arising out of personal injuries suffered by themselves/his/her child during the course of play. It is further acknowledged by the Visitor that the Visitor is responsible for the safety of the child they have brought to the UJP Facility. The Visitor further agrees to defend, indemnify and hold harmless UJP against any loss, damage or expense incurred by reason of any claim or liability based upon personal injury or property damage/loss arising out of the action of Visitor or his/her child. COVID-19 update Visitor understand that UJP takes is taking full precaution to keep the center clean and sanitized to avoid the spread of COVID-19 (commonly known as "coronavirus"). Visitor hereby exempts, releases and holds harmless UJP and its officers, agents, employees and volunteers from any and all claims or causes of action arising out of sickness due to COVID-19 suffered by themselves/his/her child. Visitor also confirms to the best of his/her knowledge that neither the visitor nor the child has been sick or showed any COVID-19 related symptoms issued by Center of Disease Control (CDC) 14 days prior of the visit to UJP center. Visitor further acknowledges that UJP is not a “drop-off” facility for open play and parties and that an authorized adult over the age of 18 must be present and/or responsible for the child at all times. GENERAL RULES AND REGULATIONS. Visitor acknowledges that UJP operates under rules and regulations established for the safety and protection of its Visitors, and agrees to be bound by such rules and Regulations as posted in the “Terms and Conditions” and 24-hour cancellation policies of UJP. All services are valid for 1 year unless otherwise noted. Pictures will be taken of the children engaged in the Company’s services. I will note below if my child’s image should be excluded from use. Facilities, equipment, hours, service, regulations and policies are subject to change from time to time, without prior notice, in the sole discretion of UJP with its Visitors enjoyment in mind. Visitor agrees to accept such reasonable change(s) as a condition of Visitorship. As a Visitor, I understand that I am entitled to use the Facility within the scope of the Visitorship that I have selected. DROP-OFF REGULATIONS AND MEDICAL RELEASE I understand that drop-off programs provide temporary child-care services, and that as the parent of the visitor, I must be reachable at all times. I will pick up my child at the appointed time in accordance with the schedule, and I understand that there will be an additional fee for late pick-up. In case of emergency or serious illness, when parents cannot be reached immediately, I hereby authorize the UJP to obtain emergency medical care and/or provide emergency medical transportation for my child/children. I give UJP permission for my child(ren) to be given CPR and first aid treatment by a certified staff member of UJP. I/we will be responsible for payment of any medical expenses incurred. I understand that it is my responsibility as the Parent/Caregiver to maintain accurate records on file, and inform the front desk of any changes to basic information or medical records. I certify that I have read the foregoing Visitor Agreement, and that by signing below, I acknowledge that I understand and agree to be bound by all of the terms and conditions hereof and may receive email and other communications from the Company from time-to-time.

Thanks for submitting!