Play Set | Systems | Indoor Open Play | Contact

Date

Is this visit for

Open Play
Private Party/Event

If Private Party/Event, who is the host?

Parent/Guardian Name

First

Last

Address

Address Line 1

City

State

Zip Code

Contact Number

Email

Child's Name

Date of Birth

Child's Name

Date of Birth

Child's Name

Date of Birth

List out any additional children's names and DOB.

As Consideration for being allowed to enter the play area and/or Participate in any party and/or program at PlayN Wisconsin, LLC the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified below, acknowledges, appreciates, understands, and agrees to the following: I represent that I am the parent or legal guardian of the Participant(s). The Participant(s) has no physical conditions or pre-existing conditions that would limit his/her participation in PlayN Wisconsin, LLC activities. I acknowledge and understand that there are risks associated with participation in PlayN Wisconsin, LLC activities and the use of the play area and play equipment including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death. I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume. I, for myself, the Participant(s) named, agree to hold harmless and indemnify the independent owner of this PlayN Wisconsin, LLC facility, their predecessors, officers, and employees from any and all injuries, liabilities or damages from participation. I have read, understand, and complete this agreement releasing all MEDICAL AUTHORIZATIONS. I hereby consent to my child(s) participation in PlayN Wisconsin, LLC and adherence to all PlayN Wisconsin, LLC’s policies and rules. I also understand that PlayN Wisconsin, LLC is not responsible for lost or stolen items. All personal items of value should not be left unattended.

I understand.

COVID 1. I am aware that the novel coronavirus (“COVID-19”) is an extremely contagious virus and that it is currently believed that COVID-19 spreads through person-to-person contact. 2. I am familiar with the Center for Disease Control and Prevention (”CDC”) guidelines regarding COVID-19, which are located at https://www.coronavirus.gov and https://www.cdc/gov/coronavirus/2019-ncov/index.html. I acknowledge and understand that the circumstances regarding COVID-19 are changing from day-to-day, and that the CDC guidelines are regularly modified and updated. I accept full responsibility for familiarizing myself with the most recent updates, and making informed choices to take precautionary measures to protect myself and others. 3. In addition to the CDC guidelines, I agree to abide by any and all policies or postings published to the general public at PlayN Wisconsin. 4. By signing this agreement, I acknowledge that I am aware of the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 at PlayN Wisconsin, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at PlayN Wisconsin may result from the actions, omissions, or negligence of myself and others. 5. I agree that, in the event that I suspect I became exposed to or infected by COVID-19 at PlayN Wisconsin and I elect to seek testing and/or treatment as a result therefrom, I will be responsible for payment of any and all medical and testing services.

I understand.

Photo Release for Minors (if under 18) PlayN Wisconsin, LLC has my permission to use my child’s and/or children’s photograph(s) publically to promote the business. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

I understand.

Signature

Clear Signature

Location & Contact Info

HOURS