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Childcare Waiver of Liability
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Parent/Legal Guardian Last Name,
City, State, ZIP
Emergency Contact Name & Phone
I acknowledge that the Pumpkin Patch Play and Plaster Craft may at any time engage in a promotion referred to as “Glow”, and other similar programs and activities, that involve the use of reduced and altered or theatrical lighting and special effects, which can increase the inherent and obvious dangers of the activity and can lead to physical or emotional injury, paralysis, death, or damage to myself, the Child, and/or third parties, and damage to personal property of any or all such persons. I understand that special rules apply to “Glow” activities, and the other programs and activities that involve the use of reduced and altered or theatrical lighting and special effects, and that I and the Child may choose not to participate in such activities. I acknowledge and agree that I may participate voluntarily in the “Glow” and other similar programs and activities solely and exclusively at my own risk, and that by participating, I waive the right to seek damages for any injuries that occur.
I further acknowledge that this agreement extends forever into the future and will have full force and legal effect each and every time I or my child(ren)/ward(s) visit Pumpkin Patch Play and Plaster Craft, whether at the current location or any other location or facility.
I hereby grant permission for Pumpkin Patch Play and Plaster Craft and its staff full authority to take whatever actions they deem necessary regarding my child’s health and safety in the event I cannot be reached or in the situation where time is of the essence; and fully release Pumpkin Patch Play and Plaster Craft and its staff from any liability in connection with those decisions. I grant permission for emergency treatment by a rescue squad, private physician and/or hospital or emergency health care facility staff if needed. Any such action will be taken in the best interest of my child and will be reported to me as soon as possible.
Adult -or- Parent/Legal Guardian Signature