Waiver Form - Play N' Learn

Parent/Guardian name first, multiple children may be on same waiver form

Name (of parent/guardian) *

First

Last

Email *

Primary Phone Number *

Secondary Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Child Name(s) *

Play N’ Learn, Inc. offers Pay to Play during certain times as a fun and carefree activity to its customers and local parents. While it is a very safe environment, the children must be supervised at all times while playing in the showroom.

Understanding *

I understand that participation in Play N’ Learn activities is risky, and that risks of injury include, without limitation, scrapes, bruises, cuts, and even more serious injuries, and I fully accept and agree to assume all of these risks (including risks arising from the negligence of other participants), for myself and my child or ward. With the full understanding of the risks stated above I, for myself and my child or ward, hereby release, hold harmless Play N’ Learn, Inc., and the owners, officers, directors and managers of such entities, and their heirs, successors and assigns, in connection with the participation of myself, my child or my ward in activities at this Play N’ Learn facility.

Binding Agreement *

I agree and understand that this agreement is binding on myself, my child or ward, and the heirs, successors and assigns of myself and my child or ward.

Certify *

I certify that I am the legal parent or guardian of the child for whom I am signing or, if I am not the parent or legal guardian of the child, that I have the express permission of the child’s legal parent or guardian.

How did you hear about us? *

Do you want to receive info on future specials and coupons? *

Yes! Count me in
No thanks